Infection prevention and control (IPAC) refers to practices that prevent or reduce the transmission of microorganisms.

As a healthcare professional, you have an important role to play in IPAC, and so do clients, care partners, and visitors. You should educate clients, care partners, and visitors about appropriate IPAC measures. Healthcare institutions usually display signs indicating to clients and visitors when to wash their hands or wear a mask, but nurses also play an important role in reminding people about the shared responsibility in reducing the spread of disease, particularly when specific precaution protocols are in place (e.g., in an isolation room, wearing a mask if someone has a cough).

Hand hygiene practices include: using an alcohol-based hand rub (ABHR), sometimes referred to as hand hygiene gel/hand sanitizer, and handwashing with soap and water. It may also include surgical hand antisepsis, which is beyond the scope of this chapter.

You should perform hand hygiene with an ABHR in front of the client prior to beginning and at the end of the examination (see Figure 3 below). The ABHR should have 70–90% alcohol concentration (Public Health Ontario, 2014).

Figure 3: Hand hygiene

Certain occasions will require handwashing instead of relying on ABHR. You must wash your hands with soap and water if your hands are visibly soiled, have been exposed to any body fluids, have been exposed to norovirus or clostridium difficile, and following glove removal (PHAC, 2012; Public Health Ontario, 2014). The mechanical action of washing hands is important to remove bacteria. See Film Clip 1 of how to properly wash your hands.

Film Clip 1: Handwashing

Reusable equipment that touches intact skin and does not touch mucous membranes must be cleaned between clients. Examples of this equipment include stethoscopes, BP cuffs, and pulse oximeters. Most of this equipment does not become visibly soiled, so disinfecting the equipment with a wipe is usually sufficient (IPAC, 2018). Depending on the equipment size, this can be achieved with an alcohol pad or a larger disinfectant wipe with 60–80% alcohol concentration (Public Health Ontario, 2018).

You should also consider your own health and safety as you provide care to clients. Personal protective equipment (PPE) such as gloves, masks, gowns, goggles, and face shields can prevent you from contact with microorganisms. Other precautions to think about include being mindful not to touch your face as you provide care because bacteria such as MRSA (methicillin-resistant staphylococcus aureus) and COVID-19 can live in the nasal passage for extended periods of time. Other ways to reduce exposure to microorganisms is to keep nails trimmed short and to keep hair tied back if it is longer than your shoulders. Avoid wearing jewelry and nail polish as they can harbor microorganisms. In addition to using PPE when appropriate, you may need to use isolation precautions for a client with a known or suspected infectious disease.

Let’s move on and talk about each of the techniques now!

Activity: Check Your Understanding

Public Health Agency of Canada (2012). Hand hygiene practices in healthcare settings. Ottawa. http://publications.gc.ca/collections/collection_2012/aspc-phac/HP40-74-2012-eng.pdf

Public Health Ontario (2018). Best practices for environmental cleaning for prevention and control of infections in all health care settings (3rd edition). Queen’s Printer for Ontario. https://www.publichealthontario.ca/-/media/documents/bp-environmental-cleaning.pdf?la=en

Public Health Ontario (2014). Best practices for hand hygiene in all health care settings (4th edition). Queen’s Printer for Ontario. https://www.publichealthontario.ca/-/media/documents/bp-hand-hygiene.pdf?la=en