Pioneering paper shows infection control and prevention in clinics is in everyone's hands

May 3, 2018 by Victoria Tagg, University of Texas Health Science Center at Houston
Luis Ostrosky, M.D. Credit: UTHealth

When it comes to the examination room at your health care clinic, you might think that avoiding catching the flu or other more deadly viruses is out of your hands, so to speak. But infectious disease experts at The University of Texas Health Science Center at Houston (UTHealth), who just published a practical guide for infectious disease control in clinics, reveal how we can all help make a difference in infection control.

A first-of-its-kind paper in Open Forum Infectious Diseases, a publication of the Infectious Disease Society of America, the step-by-step guide specifies exactly what clinicians need to do to achieve better infection prevention and control as continues to shift from hospital to outpatient settings. Previous prevention recommendations have been broad or issued in the wake of outbreaks and epidemics, but this paper promotes a more proactive and systemized approach.

While the paper is directed to providers, senior author Luis Ostrosky, M.D., professor of at McGovern Medical School at UTHealth, said patients can do their own part to hold them accountable.

"Our mantra is 'It's OK to ask.' So it's OK to ask your doctor or nurse if they washed their hands and if the instrument they are using on you is sterilized. People need to be their own advocates to make sure they're being taken care of safely," said Ostrosky, who is also vice chair for healthcare quality at McGovern Medical School and associate medical director for infection prevention at UT Physicians, the clinical practice of McGovern Medical School.

Among the key areas of focus are injection safety, cleaning and sterilization, high-level disinfection and something everyone can play a part in practicing—good .

Hand hygiene—Hailed as the cornerstone of infection prevention, this is highlighted as an issue prone to inconsistency and lack of oversight. The paper cautions that hand hygiene facilities must be placed in patient care areas, medication preparation areas and medical equipment cleaning areas.

"Patients should also make use of the hand gel sanitizer dispensers in clinic reception areas. We advocate for the use of these gels for medical professionals before and after they finish an examination," he said. "In addition, using soap and water is necessary when there's visible soiling of the hands because the gel will not wash it away."

Injection safety—The majority of reported viral and bacterial outbreaks caused by dirty syringes in recent years have occurred in outpatient settings. Common culprits were lack of access to hand hygiene facilities, reuse of vials and syringes and medication mixing. In all reported outbreaks, implementing basic prevention measures decreased subsequent transmission. Patients can also see with their own eyes whether the correct procedures are happening.

"People can make sure the injection is drawn in a sterile fashion and that an antiseptic is used. It needs to be a brand new syringe and the little stopper for the vial must be wiped. Think fresh, in front of you, sterile materials and antiseptics," Ostrosky explained.

Cleaning, sterilization, and high-level disinfection—When it comes to cleanliness, order is crucial. Older clinics tend to only have one room for cleaning reusable medical devices, so with smaller spaces it is advised to focus on the separation of clean and dirty processes.

Glucose meters, used to measure blood sugar levels, are singled out especially as needing standardization and training on disinfection. The device is cited as a priority due to its historic association with transmission of bloodborne pathogens—infectious microorganisms in blood that can cause diseases such as hepatitis. Although all facilities are not required to undergo routine regulatory audits, all clinics providing care are expected to meet standards.

First author Fozia Steinkuller, M.P.H., said, "For example, when your dental or minor procedure surgical instruments are presented to you or opened there should be a chemical indicator in the pack marking whether it has met the sterilization parameters. The other things you can ask are whether their instrument and scopes used to examine inside cavities such as the nose and colon have been reprocessed and if the people reprocessing have been trained? These are simple answers that every provider should have."

By offering clear and realistic advice, the paper aims to help all clinics, including those with more limited resources, to be squeaky clean in areas that are not externally regulated or monitored.

Airborne illnesses, such as measles and tuberculosis, are another issue demanding patients speak up. Clinics need to be notified upon or before arrival of possible infections, so appropriate precautions can be taken. In the event of a patient being known or suspected of an airborne illness, it is recommended to have a room ready and an alternative entry into the space.

"Letting the receptionist know up front should be a patient responsibility, as there's a full procedure for dealing with this. There are masks and tissues we can give the patient and a different area so they're not in the general waiting room," Ostrosky said.

"We want to prevent any transmission of infection, whether it's flu in a pediatric clinic or hepatitis in a gastroenterology clinic," he said.

As medical practice is increasingly moving out of hospitals and into clinics, antibiotic resistance, which occurs when bacteria change in a way that reduces the effectiveness of drugs, is another focus area. Viral infections, for example, do not require antibiotics but some physicians might still order them.

Ostrosky said: "We're working with our doctors and to question the use of antibiotics and we're rolling out guidelines for infections. On the patient empowerment side it's OK to ask, 'Do I really need an antibiotic?' and not demand one."

Explore further: Handwashing gets skipped a third of the time in outpatient healthcare

Related Stories

Handwashing gets skipped a third of the time in outpatient healthcare

April 11, 2016
Despite having policies in place to prevent infections, staff at outpatient care facilities fail to follow recommendations for hand hygiene 37 percent of the time, and for safe injection practices 33 percent of the time, ...

CDC establishes new 'Clean Hands Count' campaign

May 9, 2016
(HealthDay)—The U.S. Centers for Disease Control and Prevention has introduced a new campaign, "Clean Hands Count," to encourage health care professionals, patients, and patients' families to keep their hands clean in order ...

UPMC investigation into GI scope-related infections changes national guidelines

October 9, 2014
National guidelines for the cleaning of certain gastrointestinal (GI) scopes are likely to be updated due to findings from UPMC's infection prevention team.

Study measures impact of education, information on hand hygiene compliance

October 29, 2013
How often do you clean your hands? A study at Rhode Island Hospital observed staff on 161,526 occasions to monitor how often they cleaned their hands (ie, hand hygiene) between July 2008 to December 2012 and found that hand ...

New pediatric infection prevention guidelines for residential facilities

September 18, 2013
With the evolving changes in the delivery of healthcare to children worldwide, which frequently include long-distance travel and lodging for specialized medical treatments, the Society for Healthcare Epidemiology of America ...

Hospitalized patients don't wash their hands enough, study finds

October 7, 2014
Hospital visitors and staff are greeted with hand sanitizer dispensers in the lobby, by the elevators and outside rooms as reminders to wash their hands to stop infections, but just how clean are patients' hands?

Recommended for you

Dengue: Investigating antibodies to identify at-risk individuals

May 23, 2018
Using an original mathematical and statistical analysis method, a team of scientists from the Institut Pasteur partnered with researchers from the United States and Thailand to analyze a Thai cohort that has long been a focus ...

Fatty liver disease research set to benefit from stem cell advance

May 23, 2018
Scientists have developed a lab-based system for studying the most common type of liver disease, paving the way for research into new therapies.

More frequent checks control MRSA in newborns, but can hospitals afford them?

May 22, 2018
The more often a hospital can check its newborns for deadly MRSA germs, the more likely it will be that they are contained, according to a new study.

Could we predict the next Ebola outbreak by tracking the migratory patterns of bats?

May 22, 2018
Javier Buceta, associate professor of bioengineering, Paolo Bocchini, associate professor of civil and environmental engineering, and postdoctoral student Graziano Fiorillo of Lehigh University have created a modeling framework ...

Helping preterm infants grow bigger kidneys would prevent kidney disease later in life

May 21, 2018
Nephrons are the microscopic blood-filtering units inside our kidneys that convert waste products into urine, regulate our electrolyte levels and our blood pressure.

Kidney docs worry over no dialysis for undocumented immigrants

May 21, 2018
(HealthDay)—Undocumented immigrants in the United States are often denied treatment for kidney failure until they have a life-threatening emergency. Now a new study finds that the doctors and nurses who treat them are frustrated ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.