Falta de fundamentación del recurso

The approach to containment of a hazard is to implement a Hierarchy of Controls. The first level of control is engineering interventions. If this level of control is not possible or adequate, then administrative interventions are used. Last in the Hierarchy of Controls is PPE. PPE is not the first control measure as the use is dependent on variables of worker adherence. An understanding of the engineering, administrative (including patient care practices), and PPE controls enables health care organizations to determine how the health care environment in each setting (e.g. infrastructure, equipment, processes and practices) increases or decreases a susceptible host’s (e.g. patient, HCW, visitor, etc.) likelihood of exposure to a microorganism/infected source within the health care setting.

1. Engineering Controls

The engineering control tier reduces the risk of exposure to an infectious agent/infected source hazard by applying building structure or ventilation strategies. Engineering controls do not depend on an individual’s compliance with exposure prevention strategies. These controls are usually established and controlled within the building structure, thereby eliminating an individual’s choice

about their application and reducing the opportunity for individual error. As such, they provide more effective protection.

2. Administrative Controls

The administrative control tier provides an infrastructure of policies and procedures and patient care practices intended to prevent exposure to and/or transmission of microorganisms to a susceptible host during the provision of health care. To be effective, administrative controls must be implemented at the point of first encounter with an infected source and be continued until the infected source leaves the health care setting or is no longer infectious. Inherent in the development of administrative controls to prevent transmission of infection is the commitment by the health care organization to provide the necessary resources to implement the controls.

3. Personal Protective Equipment

Although the use of PPE controls are the most visible in the Hierarchy of Controls, PPE controls are the weakest tier in the Hierarchy of Controls and should not be relied on as a stand-alone primary prevention program. The PPE tier provides a physical barrier between the uninfected and an infectious agent/infected source. These barriers include: gloves, gowns, masks, facial protection, eye protection, (including face shields,

masks with visor attachments), and N95 respirators. The health care organization must ensure the availability of appropriate PPE for use by patients, HCWs, visitors, contractors, etc. to prevent exposure to an infectious agent/infected source.

Focusing only on availability and use of various PPE to the exclusion of other tiers in the Hierarchy of Controls will result in suboptimal protection of all persons in the health care setting, including patients, HCWs and other staff. The effective and appropriate use of PPE is the control that is most reliant on the user’s adherence and competence and is, therefore, the control most easily compromised (resulting in ineffective protection from an infectious agent/infected source). See Appendix IV, Technique for Putting on and Taking off PPE.

Table 2: Examples of Control Measures According to Hierarchy of Controls

TIER 1: Examples of Engineering Controls

•  Source control

 Single rooms with private toilets, patient sink,

designated staff hand washing sinks

 Airborne infection isolation rooms (AIIRs)

 S ignage to direct patients to separate entrances

(during community outbreaks) for patients symptomatic with respiratory infections

 Physical barriers, e.g. partitions in triage areas to

prevent exposure to patients symptomatic with respiratory infections

 Appropriate ventilation, which may include

natural ventilation in the home , when appropriate

•  Installation of

 Point of care ABHR

 Point-of-use sharps containers

 Appropriately functioning, accessible dispensers

for hand hygiene products (ABHR, soap, lotion, paper towels) and respiratory hygiene/cough etiquette products

 Designated hand washing sinks for HCW use

•  Appropriate number of commodes

•  Appropriate supply of and accessibility of PPE •  Appropriate number of accessible hands-free

receptacles for disposal of paper towels, tissues, masks, gloves etc.

TIER 2: Examples of Administrative Controls

•  Appropriate resources for diagnosis and treatment of infection or colonization and for immunization of patients and staff

•  Organizational support for effective IP&C and OH services and for management of outbreaks

•  Appropriate OH and safety policies, including pre- placement assessment, work restrictions, Respiratory Protection Program, sharps safety and prevention of exposure to BBPs and immunization programs •  Education of HCWs

•  Policies, procedures and resources to support the application of:

 Point of Care Risk Assessment (PCRA)

 Point of care ABHR as the standard of care in all

health settings

 Routine Practices as the standard of care for all

patients in all health care settings

•  Source control (instructions for patients) •  Patient placement, transport and movement •  Aseptic technique

•  Dedicated patient care equipment and cleaning of non-critical equipment between patients

•  Reprocessing (cleaning, disinfection and sterilization) of reusable patient care equipment

•  Environmental cleaning •  Management of linen, waste •  Management of visitors

•  Additional Precautions when PCRA determines Routine Practices are not sufficient (e.g. AIIR) respiratory protection)

• _{TIER 3: Examples of Personal Protective}

Equipment to Prevent Exposure of Patients, HCWs and other Staff

Following PCRA, personal protective equipment for the appropriate application of Routine Practices and Additional Precautions may include:

•  Gloves •  Gowns

•  Masks (surgical or procedure masks used by HCW and/or infectious source)

•  Facial protection (masks and eye protection, face shields, masks with visor attachment)

B. Organizational Responsibilities