Infection Prevention Principles Research Articles

A multi-institute, follow-up, observational study measuring nursing students' adherence to infection prevention and control protocols in Saudi Arabia.

Nursing students learn principles of infection prevention and control (IPC) and hand hygiene (HH) in clinical courses, and their learning is reflected in their practice. The knowledge, attitude, and practice of principles of IPC and HH of the students were measured prior to and after attending an educational workshop. The adherence of the students to the IPC and HH protocols at the hospital was also observed. This study included a pretest-posttest time series follow-up and an observational part. During the first part of the study, students attended a workshop, which was preceded by a pretest. It was then followed by a posttest directly after finishing the workshop and in 12 weeks. Participants were submitted to an observational part by a trained observer to document certain skills taught earlier during the workshop. Students from three nursing schools in Saudi Arabia participated in the study. A total number of 130 completed the study protocol, and 100 completed the observation part. Students were found to experience an improvement in their knowledge, beliefs, and commitment scales after the workshop. The attitude scale remained relatively unchanged over different tests. Most students performed the skills properly and adequately, but some failed to perform certain skills, like hand rub, and the proper use of disinfectants.

The role of online marketing to engage healthcare workers with infection prevention and control information and resources: A pilot study.

The successful adoption and application of infection prevention and control (IPC) principles in all healthcare settings is dependent on the degree to which healthcare workers (HCWs) are aware of the requirements, have access to program resources and information, and engage with the IPC program. This study investigates the impact of redesigning the Infection Control Department (ICD) intranet site based on user feedback followed by a targeted marketing campaign to improve website usability, awareness, and access. In this systematic study, we used a survey plus two focus group interviews to elicit user requirements for the content and look of the ICD intranet page and identify the best communication platforms to use for the marketing campaign to launch the redesigned intranet page. The information was used to redesign the intranet page and develop the marketing campaign. The survey was repeated post-intervention and these results, along with a comparison of website analytics monitoring traffic, were used to determine the success of the intervention. The ICD intranet page redesign increased the information and resources. Post-intervention survey results demonstrated a significant improvement in user satisfaction including ease of navigation and access to IPC information and resources. The marketing campaign resulted in a significant increase in website traffic to the ICD intranet page, demonstrating enhanced engagement with HCWs. This study demonstrated that website redesign based on user feedback, combined with a marketing campaign, can increase the traffic to the website and improve the user experience when accessing and navigating the site making the information and resources more accessible to HCWs.

PURPOSE OF NURSES IN INFECTION CONTROL AND PREVENTION IN MEDICAL MANAGEMENT. A NEW APPRAISAL

Infection Control activity works in tandem with all healthcare disciplines to provide quality patient care through education and practical application of the principles of microbiology, epidemiology, and infection prevention and control.Infection prevention and control (IPC) is a practical, evidence-based approach that prevents patients and health workers from being harmed by avoidable infection as a result of antimicrobial resistance. No one should catch an infection while receiving health care, yet, these infections can spread through outbreaks and many regular care practices, affecting hundreds of millions of people across the world every year. Infection prevention and control is one of the first topics introduced in nursing programs, yet its main tenets are often lost or forgotten. Objectives: The main objective of these guidelines is to prevent the health care workers and the environment from the transmission of infections. The specific objectives of these guidelines are to provide directions and information in relation to facilities, equipment, and procedures necessary to implement standard and additional (transmission-based) precautions for control of infections Cleaning, disinfecting and reprocessing of reusable equipment, Waste management, Protection of health care workers from transmissible infections, Prevention of HAI in patients, Infection control practices in special situations.

Infection Prevention Education Simplified: The Pros and Cons of Using CDC’s Project Firstline

Education is an important component of a successful infection prevention program. Although most infection preventionists recognize the need for education, there is limited time to devote to this endeavor. The Centers for Disease Control and Prevention released an educational program to help educate frontline healthcare workers about infection prevention principles. It can be a useful resource to meet the educational needs in a healthcare organization or facility; however, there are some barriers to using the program as written.

Healthcare workers exposure risk assessment in the context of the COVID-19: a survey among frontline workers in Qazvin, Iran

BackgroundHealthcare workers perform various clinical procedures for COVID-19 patients facing an elevated risk of exposure to SARS-COV-2.This study aimed to assess the healthcare workers’ exposure to COVID-19 in Qazvin, Iran in 2020.MethodsWe conducted this descriptive-analytical study among all healthcare workers on the frontline of exposure to COVID-19 in Qazvin province. We entered the participants into the study using a multi-stage stratified random sampling method. We utilized a questionnaire, "Health workers exposure risk assessment and management in the context of COVID-19 disease", designed by the World Health Organization (WHO) to collect data. We analyzed data using descriptive and analytical methods with SPSS software version 24.ResultsThe results showed that all participants in the study had occupational exposure to the COVID-19 virus. So of 243 healthcare workers, 186 (76.5%) were at low risk and 57 (23.5%) at high risk of COVID-19 virus infection. Also, from the six domains mentioned in the questionnaire, health workers exposure risk assessment and management in the context of COVID-19 disease, the mean score of the domain of the type of healthcare worker interaction with a confirmed COVID-19 patient, the domain of health worker activities performed on a confirmed COVID-19 patient, the domain of the adherence to infection prevention and control (IPC) during health care interactions, and the domain of the adherence to IPC when performing aerosol-generating procedures in the high-risk group were more than the low-risk group.ConclusionDespite strict WHO guidelines, many healthcare workers are exposed at contracting COVID-19. Therefore, healthcare managers, planners, and policymakers can revise the policies, provide appropriate and timely personal protective equipment, and plan for ongoing training for staff on the principles of infection prevention and control.

INFECTION CONTROL PROTOCOLS IN SPECIALIST DENTAL CENTRE AT SAUDI ARABIA. A NEWAPPRESIAL

Context Although the principles of infection prevention and control remain unchanged, new technologies,materials, equipment and updated data require continuous evaluation of current infection control practicesandcontinuouseducationfor theoralhealthteam. Scope This policy statement provides the basic principles of infection prevention and control. More detailedinformationcanbefound inthe referencesandinrelevant legislation. Definitions Infection prevention and control (IPC): scientific approach and practical solution designed topreventharmcausedby infectiontopatientsand healthworkers. Standardprecautions:Guidelinesforthepreventionoftransmittablediseasesincludingnosocomialinfection.Standardprecautionscombineuniversalprecautionsandbody-substanceprecautionsforallpatientsregardlessof diagnosisor possible infectiousstatus. Principles It is the responsibility of dentists to establish a protocol that prevents or limits the spread ofinfectionindentalpracticefortheirpatients,theirstaffandthem-selves.Thiscanbeaccomplishedbyfollowingthe recommendedinfectioncontrolworkpractice procedures. PolicyFDIsupportsthefollowingstatements: Recommendations,guidelinesandregulationsshouldbedevelopedinconsultationwiththedentalprofession. • Recommendations, guidelines and laws affecting standard precautions required of dental practices must beevidence-based or based on international best practices and receive adequate financial compensation for theadditionalcoststhatareincurred. • Local/regional dental associations should educate the public on the importance of proper infection controlin the dental office, the effectiveness of such recommended procedures and consequently the absence of asignificant riskofcontractingtransmittable diseasesthrough theprovisionofdentalcare. • Dentaleducatorsmustincorporatecurrentinfectionpreventionandcontrolrecommendationsinhealthcare settings into the curriculum and during clinical activities. This should include a blame-free criticalincidentreportingandlearningsystem.

Patient safety culture as a space of social struggle: understanding infection prevention practice and patient safety culture within hospital isolation settings - a qualitative study

BackgroundIn recent times, infection prevention and patient safety have become a global health policy priority with thought being given to understanding organisational culture within healthcare, and of its significance in initiating sustained quality improvement within infection prevention and patient safety. This paper seeks to explore the ways in which engagement of healthcare workers with infection prevention principles and practices, shape and inform patient safety culture within the context of hospital isolation settings; and vice-versa.Research methodsIn this paper, we utilise focus group interviews at two hospital sites within one health board in order to engage healthcare staff in elaborating on their understandings of infection prevention practices and patient safety culture within isolation settings in their organisation. Focus group transcripts were analysed inductively using thematic analysis in order to identify and develop emerging empirical themes.ResultsPositioned against a background of healthcare restructuring and ever-increasing uncertainty, our study found two very different hospitals in regard to patient safety culture and infection prevention practice. While one hospital site embodies a mixed picture in regard to patient safety culture, the second hospital is best characterised as being highly fragmented. The utilisation of focus group interviews revealed themes that capture the ways in which interviewees position and understand the work they perform within the broader structural, political and cultural context, and what that means for infection prevention practice and patient safety culture.ConclusionDrawing on the insights of Bourdieu, this paper theorises the field of patient safety as a space of social struggle. Patient safety is thus positioned within its structural, cultural and political context, rather than as merely an epidemiological dilemma.

A Study to Evaluate the effectiveness of Self-Instructional Module on Knowledge and Practice regarding infection control strategies among Staff Nurses working in Labour room at selected Hospitals, Chamarajanagar

Introduction: Infection prevention and control is an integral component of nursing care delivery in any setting to reduce risks for morbidity and mortality in patients and care givers at all levels. Basic principles of infection prevention are simple and include personal hygiene and hand washing. Nurses are on the front line to answer questions from patients and families when the media report outbreaks of exotic infectious diseases and the development of new super pathogens associated with health care. The most common infections acquired in the hospital setting and focus on the nurse’s role in prevention. Hence the focus of this study was to evaluate the effectiveness of Self-Instructional Module on infection control strategies among staff nurses at selected Hospitals, Chamarajanagar. Objectives: 1. To assess the knowledge and Practice of infection control strategies among Staff Nurses Working in Labour Room, in terms of pre-test knowledge scores. 2. To assess the effectiveness of Self-Instructional Module on knowledge and Practice of Infection control strategies among Staff Nurses by comparing the pre and post-test Knowledge score. 3. To find the association between post-test knowledge scores with their selected demographic Variables of Staff Nurses. Methods: A pre-experimental design and evaluative approach was used in the study. The data was collected from 50 subjects; through purposive sampling technique. Data was collected using structured questionnaire. Major Findings of The Study: The overall analysis of level of Knowledge of staff nurses regarding infection control strategies showed that mean Knowledge scores of the subjects at pre-test were 14.7 (49%) with standard deviation 2.823 found to be moderate Knowledge regarding infection control strategies. After administration of Self-Instructional Module mean Knowledge scores of the subjects was 22.84 (76.13%) with standard deviation 2.787 found to be improvement in the level of Knowledge among staff nurses. Among the participants 60% of the staff nurses had inadequate Knowledge and 40% had moderate Knowledge in the pre-test. After administration of the Self-Instructional Module 62% of the subjects had adequate Knowledge, 38% had moderate Knowledge regarding infection control strategies in the post test. The analysis of practice reveals that 48% of the staff nurses had poor Practice and 52% had moderately good Practice in the pre-test. After administration of the Self-Instructional Module 62% of the subjects had Good Practice and remaining 38% had moderately good practice regarding infection control strategies in the post test. The Overall mean practice scores of the respondents was found to be 7.06 (47.06) with the standard deviation of 2.014 which indicates the poor practice of infection control strategies in pre-test. After administration of self-instructional module the overall practice scores of respondents were found to be 11.08 (73.86%) with standard deviation 1.967 shows improvement in the practice of staff nurses regarding the infection control strategies. Interpretation and Conclusion: Findings of the study show that there was a significant difference in pre-test and post-test level of Knowledge and Practice of staff nurses. From this it is concluded that the Self-Instructional Module is effective in improving the level of Knowledge and Practice of staff nurses. And there was a significant association between level of Knowledge and Practice of staff nurses and selected demographic variables such as Age, gender, religion, professional qualification, area of working, experience, source of information and attendance of in-service education programme.

Environmental cleaning and infection prevention and control: The role of Patient Service Assistants.

In Australia, Patient Service Assistants are an integral part of all health care settings, yet there is a paucity of studies considering their understandings and perceptions of their role about infection prevention and control. The aim in this study was to explore haematology Personal Service Assistants' experience, understanding and perceptions of their role in improving patient safety through environmental cleaning. A qualitative exploratory descriptive design was utilised to collect data from cleaning staff via focus groups. Three semi-structured focus groups were conducted. Seven Patient Service Assistants participated in the study out of 11 employed. Two key themes emerged from the thematic analysis: (1) Playing a major role in Infection Prevention and Control, and (2) prioritising good interpersonal relationships over promoting infection prevention and control. Patient Service Assistants emphasised the importance of their involvement in keeping the ward clean, including patients' rooms and surroundings, to prevent cross infection. Most participants underlined the dilemmas they faced when visitors and/or informal cleaning employees or casual ward staff did not adhere to ward infection prevention and control norms. Patient Service Assistants were employing key infection prevention and control principles in their ward cleaning routine, with the aim of achieving a safer patient environment although they were reluctant to challenge observed practice deviations. The role of Patient Service Assistants highlights the widely held misconception that patient safety is solely dependent on healthcare workers.

Stewardship of Personal Protective Equipment (PPE) During a Pandemic

BackgroundThe use of PPE is fundamental in protecting healthcare workers (HCWs) from being exposed to SARS-CoV2. The pandemic caused global PPE shortages forcing institutions to address appropriate utilization and conservation. Initial efforts to limit PPE distribution to avoid misuse and frequent changes in public health guidance created confusion and apprehension amongst HCWs.MethodsInfection Prevention and Control (IP&C) implemented a PPE stewardship initiative, consisting of daily rounds on patients positive or suspected of COVID-19. Principles included: 1.) supporting HCWs caring for these patients, 2.) assure implementation of infection prevention principles for a safe environment, 3.) advise on appropriate PPE and isolation precautions with respect to patient acuity, and 4.) promote best practices aligning with the most up-to-date guidance.Rounds addressed questions and concerns regarding PPE availability and utilization. We partnered with Nursing and Respiratory Therapy to alleviate demands on IP &C. The "PPE Spotters" team, monitored and optimized PPE utilization, supply, and distribution; provided training on donning/doffing, PAPR use, PPE reuse; and provided general support to HCWs for questions.ResultsWe measured number of isolation days of confirmed or suspected patients with COVID-19 and the numbers of N95 masks distributed to units during the 4-week period before (18.2 mask per isolation day) and the 8-week period after (3.0 masks per isolation day) the PPE Spotter team was formed. Our PPE stewardship efforts successfully limited N95 misuse as community COVID-19 burden increased.ConclusionsThis multi-disciplinary resource, particularly during periods of evolving PPE guidance and supply chain insecurity, was vital. Additionally, it expanded the pool of staff to advocate for HCW safety and IP&C principles.All HCWs can benefit from learning about this novel model that can be adapted to any institution and various scenarios. We recently adopted this model to support staff in psychiatry with an influx of patient volumes and their needs.

How to Create a Consolidated Infection Prevention Program Across a Health Care System with Diverse Member Organizations

BackgroundAn evaluation of an infection prevention and control program of a healthcare system with diverse member organizations and 12,000 employees throughout one state, revealed inconsistent infection prevention policies and procedures. These inconsistencies led to confusion among staff who worked at a variety of facilities and further led to evidenced based Infection Prevention principles not being well implemented or practiced.MethodsThrough a retrospective program analysis evaluation, the Infection Prevention System Council within the health care system was able to identify areas of improvement to standardize practice across the system including the development of a new system wide leadership position, formal consultations for infection prevention needs and policy and procedural development at the system level as opposed to an individual member organization level. A total of 10 hospitals and 7 separate entities such as medical transport and home care and hospice participated in this program restructure.ResultsSignificant increase in employee engagement from infection preventionists across the system as a result of the restructure, which led to systemized policies and procedures. Additionally, the Infection preventionists in each facility had more autonomy as subject matter experts and were utilized in key events such as the COVID 19 pandemic. The cohesive approach to infection prevention also led to greater support from senior leadership which resulted in the Infection prevention team being allotted financial resources for pivotal initiatives to improve healthcare associated infections.ConclusionsA single consistent Infection Prevention approach across an entire health care system provides a more engaged workforce with greater autonomy and resources which in turn lead to resource allocation and improved evidenced based infection prevention principles being implemented for the safety of both health care staff and patients.

Risk management and infection control preparedness of Saudi healthcare facilities to overcome the COVID-19 pandemic

ObjectiveTo evaluate the preparedness of Saudi healthcare facilities to handle the coronavirus disease 2019 (COVID-19) pandemic.MethodsBetween April and June 2020, a cross-sectional study was conducted among Saudi hospitals using an online-administered English-language questionnaire by the Saudi Commission for Health Specialties. The questionnaire evaluates all aspects of risk management, infection control and preventative programmes that should be known and practised by all healthcare workers (HCWs). All HCWs in Saudi hospitals designated to accept patients with COVID-19 were involved in the study.ResultsIn total, 161 HCWs responded to the survey. General understanding of hospital risk management plans and infection prevention measures was found to be outstanding (80.4%), with no differences in responses by gender, education or occupation. Some differences in responses were found by age group and years of working experience. Most responses were from hospitals located in the Central Province (72.7%) and governmental hospitals (88%), and most provided family services (68%). Furthermore, the results showed that medical professionals received adequate training, which is recognized as the baseline for effective risk management and infection control and prevention procedures, policies and recommendations.ConclusionsNotwithstanding small differences between HCWs, this study found that all HCWs in Saudi hospitals had excellent knowledge of risk management plans and pandemic sub-plans of infection control and prevention policies, procedures and principles, which has aided the health authorities in Saudi Arabia in mitigating COVID-19 effectively.

Predictors of contracting COVID-19 in nursing homes: Implications for clinical practice.

The aim of the study was to identify the predictors of contracting COVID-19 among older people in nursing homes in Iran. A case-control study. Four-hundred-nine nursing home residents aged 60years and above, with a 1:2 ratio of those infected with SARS-CoV-2 to those not infected, from six nursing homes in Tehran between 25 March and 12 July 2021 were recruited. Participants completed a questionnaire comprising demographic and underlying disease questions, practice about prevention principles of SARS-CoV-2 infection, probably predisposing factors of the infection, and environmental and staff characteristic of nursing homes. Logistic regression was used to determine risk factors associated with contracting COVID-19. The mean age was 77.37 (±9.20) years; 54% were female. A logistic regression model showed that the most important predictors of becoming infected by SARS-CoV-2 included not using mask outside the room (odds ratio [OR]: 3.37, 95% CI: 1.74-6.53), longer staff shifts (OR: 3.02, 95% CI: 1.68-5.43), using cloth mask or not wearing a mask (OR: 2.47, 95% CI: 1.13-5.42) and not having glass barrier in visitors space (OR: 1.95, 95% CI: 1.11-3.50). The results indicate that an increase in older people becoming infected by SARS-CoV-2 in nursing homes is probably because of not wearing a mask in common places, use of a cloth mask, longer staff shift durations and not having a glass shield when interacting with visitors from outside of nursing homes. The predictors identified in this study can assist in reducing SARS-CoV-2 infections in older people institutionalized in nursing homes. These data items can also inform the development of interventions to improve principles of infection prevention and control.

432. An Outbreak of Coronavirus Disease, 2019 (COVID-19) in a Skilled Nursing Facility – California, 2021: Description, Mitigation, Challenges, and Opportunities

BackgroundSkilled nursing facility (SNF) residents comprised 11% of all COVID-19 cases in the United States; however, they account for 43% of deaths with case fatality rates (CFR) of 26.0-33.7%. MethodsWe report an outbreak of COVID-19, from June 15 to July 21, 2020 in a 159-bed SNF with a staff of 172 that resulted in an infection rate of 97% in residents and 23% in HCWs (Figure 1). A retroactive review outlined mitigation efforts, discussed challenges, identified risk factors among residents and health care workers (HCW) for acquisition of COVID-19, and reviewed opportunities for improvement (Figure 2). Figure 1. Epi Curve of COVID-19 Outbreak in a Skilled Nursing Facility Figure 2. Timeline of COVID-19 Outbreak in a Skilled Nursing FacilityResultsFactors that contributed to the outbreak: delay in test results had an impact on cohorting; suboptimal adherence to the principles of infection prevention and control (IPC) and minimal adherence monitoring; strict criteria were used to screen for infection; the underappreciated transmissibility of COVID-19 from presymptomatic and asymptomatic persons; symptomatic HCWs who continued to work; the changing guidance on, the suboptimal use of, and an inadequate supply of personal protective equipment; poor indoor air quality due to ventilation challenges; and the important role of community/family/interfacility spread on the outbreak. Whole genome sequencing, performed in 52 samples, identified a common strain that was also found in clusters of 2 other facilities: 1 in the same geographic location, the other in a different geographic location but whose HCWs had the same zip codes as the facility (Figure 3). Certified nursing and restorative nursing assistants had the highest risk of infection with an odds ratio (OR) of 4.02 (confidence interval 1.29-12.55, p value: 0.02) when compared to registered and licensed vocational nurses. The residents’ CFR was 24%. The OR for death was increased by 10.5 (10.20-11.00) for every decade of life as was morbid obesity (BMI > 35) with an OR of 8.50. BMI as a continuous variable increased risk of mortality for every additional unit, OR 1.07 (Tables 1, 2). Whole Genome Sequencing of Isolates from a Skilled Nursing Facility Outbreak Univariate Analysis of Selected Variables Associated with Mortality among Residents at Facility A during COVID-19 Outbreak, June 19 - July 21, 2021 Multivariate Analysis of Factors Associated with Mortality from COVID-19 after Adjusting for Age among Residents (N =124) of Facility A, June 15 - July 21, 2020ConclusionWhile implementation of optimal IPC measures in the pre-COVID-19 vaccination era had no impact on the infections in residents who were likely already infected or exposed at the onset of the outbreak, these measures along with non-pharmacologic strategies were effective in halting the spread among HCWs.Disclosures All Authors: No reported disclosures

Infection prevention and control considerations regarding ventilation in acute hospitals

SummaryInfection prevention and control team members (IPCTM) are often intimidated by aspects of ventilation as they relate to healthcare, because they consider them technical and outside their area of comfort and expertise. However, engineers, estates departments and planners need IPCTM input to ensure appropriate design and use. The main areas of importance centre on the operating theatre, the provision of air-controlled ventilated isolation rooms, and how to respond to major outbreaks/pandemics. Concentrating on basic principles of infection prevention and control, developing relationships with key departments and individuals, and applying best practice to these and other areas as they arise, are of great value. Some background, information and suggestions are provided for IPCTM with a view to providing simple practical advice in these areas.

Knowledge, Perceptions, Satisfaction, and Readiness of Health-Care Providers Regarding COVID-19 in Northern Ethiopia.

BackgroundTo protect health-care providers (HCPs) from COVID-19, the WHO recommends applying basic principles of infection prevention and control measures at all health-care facilities. This study aimed to assess the knowledge, perceptions, satisfaction, and readiness of HCPs regarding COVID-19 in Tigrai, Ethiopia in 2020.MethodsThis cross-sectional study was conducted from June 1 to July, 2020. Data were collected using a self-administered structured questionnaire. Multistage sampling followed by purposive sampling were used to recruit study subjects. SPSS 21 was used to compute proportions and χ2 to identify risk factors.ResultsOf 765 participants, 88% had adequate knowledge, close to a third showed positive perceptions and were satisfied with their job and nearly a quarter demonstrated readiness to prevent and control COVID-19. Education, knowledge, readiness, perceptions, and job satisfaction with associated with type and readiness of health facilities.ConclusionDespite adequate knowledge of the HCPs about COVID-19, their perceptions and job satisfaction are a concern for the health-care system. Only one in five HCPs was found to be ready to prevent and control COVID-19. Efforts should be exerted to improve perceptions, job satisfaction, and readiness of HCPs to fight COVID-19.

Rational use of antimicrobials during COVID-19 times in Peru: role of antimicrobial stewardship programs and interventions in terms of infection control

Antimicrobial resistance (AMR) is an additional slow-evolving pandemic that precedes the COVID-19 pandemic and will continue when it ends. However, in countries such as Peru where there is high consumption and inadequate prescription of antibiotics, a more challenging future scenario can be expected. Antimicrobial Stewardship Programs (ASP) are multidisciplinary teams of professionals that aim to contain the emergence of multidrug-resistant organisms through strategies such as audit of antibiotic prescription or creating antibiotic treatment guidelines based on local AMR rates. The difficulty in the timely diagnosis of co-infections or superinfections in the clinical course of COVID-19 leads to inappropriate use of antibiotics, forcing ASP to adapt their strategies in this changing scenario. In Latin America, ASP not only has to promote behavior change in antibiotic prescribers but also fight the epidemic of false information (infodemia) and disinformation campaigns on COVID-19. Furthermore, poor-quality infection prevention and control principles require evaluating strategies to mitigate the subsequent impact on the AMR.

Understanding the principles of infection prevention and control.

Nurses have a crucial role in infection prevention and control. The coronavirus disease 2019 (COVID-19) pandemic has emphasised the importance of controlling the spread of infections, while reinforcing the challenges involved in the care of patients who already have an infection. This article discusses important elements of theory and practice related to infection prevention and control. The author also explores various areas that have come to prominence as a result of the COVID-19 pandemic, including measures such as risk assessment, the use of personal protective equipment, the role of surveillance, and outbreak management.

COVID-19 pathway signage for operating theatres.

On 20 August 2020, Public Health England released a new version of the 'COVID-19: Guidance for the remobilisation of services within health and care settings: infection prevention and control recommendations', superseding that of 18 June 2020. In this document, the infection prevention and control principles determine that the treatment, care and support of patients are to be managed in three COVID-19 pathways. These are: 'high risk', 'medium risk' and 'low risk'. In the operating theatre, where procedures may be urgent or planned, and where various surgical and anaesthetic procedures generate airborne particles (aerosols), it is crucial to communicate the infection prevention and control recommendations in a way that is easily understood and followed by all healthcare professionals. The theatre team at one hospital in the East of England produced local alternating signage to communicate the COVID-19 pathway risk during cases in theatres. This signage - named the 'COVID-19 Flag' - is placed outside of the individual theatre to ensure that staff are informed of the infection risk with the cases underway. Furthermore, it is a quick visual guide to be used in conjunction with national guidance and local protocols for appropriate decisions regarding the treatment and care of patients in the operating theatres.

Rewriting the playbook: infection prevention practices to mitigate nosocomial severe acute respiratory syndrome coronavirus 2 transmission.

Given the limited evidence and experience with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this novel pathogen has challenged the field of infection prevention. Despite uncertainty, infection prevention principles and experience with similar diseases have helped guide how to best protect providers and patients against disease acquisition. Guidance to date has relied on data from SARS-CoV-1 and MERS-CoV to guide practices on patient isolation and personal protective equipment (PPE) use. Although a face mask and eye protection are likely adequate for most clinical scenarios, published guidelines for PPE can be confusing and conflicting. Consensus for what constitutes a high-risk aerosol-generating procedure (AGP) is lacking, but most agree providers performing procedures such as bronchoscopy, intubation, and cardiopulmonary resuscitation would likely benefit from the use of an N95 respirator and eye protection. Needed research to elucidate the predominant SARS-CoV-2 mode of transmission is not likely to be completed in the immediate future. Recommendations for PPE to mitigate procedure-associated risk remain controversial. Nonetheless, implementation of existing measures based on basic infection prevention principles is likely to prevent transmission significantly.