Administrative Strategies for Preventing the Transmission of Infectious Diseases
Laura M. Cascella, MA, CPHRM
Individuals in the healthcare community have long considered infection prevention and control (IPC) strategies critical to patient safety, worker safety, and overall public health. The criticality of these measures is even more pronounced in the wake of the coronavirus disease 2019 (COVID-19) pandemic and in preparation for potential future infectious disease outbreaks.
Often, IPC efforts focus on following standard precautions and transmission-based precautions, appropriate use of personal protective equipment (PPE), sterilizing and disinfecting reusable equipment, using safe injection techniques, and implementing practices that support antibiotic stewardship.
In addition to these approaches, numerous administrative strategies can help healthcare practices reduce the transmission of infectious diseases. Administrative strategies refer to work policies and procedures, education and training, wellness approaches and initiatives, and compliance monitoring to reduce the risk of pathogen exposure.
The following administrative strategies are high-level recommendations to consider when developing or updating IPC protocols.1 Because healthcare practices vary, each practice should develop protocols that address the types of services offered and the needs of providers, staff, and the patient population.
- Develop written, evidence-based policies that address infection prevention and occupational health (e.g., adherence to bloodborne pathogen standards, vaccination recommendations, respiratory protection, etc.).
- Develop and implement employee sick leave policies that are nonpunitive, flexible, and encourage healthcare providers and staff members who are sick to stay home.
- Procure sufficient and appropriate supplies to allow healthcare providers and staff members to adhere to standard precautions (e.g., PPE and injection equipment).
- Implement a system at initial points of patient encounter for early detection and management of individuals who have potentially infectious diseases. Strategies might include using specific phone screening questions and rescheduling nonurgent care for patients who are ill.
- For airborne illnesses:
- Consider a categorized approach to scheduling that reserves earlier appointments for general wellness visits and later appointments for patients who have, or might have, airborne illnesses.
- Determine if it is feasible to have patients who have airborne illnesses enter and exit the practice through a separate entrance to limit other patients’ exposure to pathogens.
- Post signs at office entrance(s) that advise patients who have signs/symptoms of airborne illnesses to notify staff via telephone before entering the office or immediately during patient registration. Make sure signs are in languages appropriate for the patient population.
- Implement a protocol to put patients who have, or may have, airborne illnesses directly in an exam room or separate waiting area, rather than having them wait in the general reception area.
- Post signs throughout the office to educate providers, staff members, patients, and visitors about the importance of, and best practices for, hand hygiene and respiratory hygiene. Laminate all signs so that staff members can easily clean them.
- Ensure sufficient hand hygiene and respiratory hygiene supplies are available for reception, waiting areas, patient care areas, and restrooms. (Note: Make sure alcohol-based hand rub is not in reach of children.)
- When possible, use touchless waste containers, soap and hand sanitizer dispensers, faucets, and paper towel dispensers.
- Consider implementing physical safeguards to ensure social distancing in waiting areas, especially during infectious disease outbreaks. Examples of these safeguards include spacing out chairs, reducing wait times, asking patients/visitors to wear masks, and limiting the number of people in waiting area at any particular time.
| Toys in Waiting Areas |
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| Healthcare practices that plan to maintain toys in waiting areas should make sure to select toys that can be easily cleaned and disinfected. Practices should consider developing a plan that delineates how toys should be cleaned, how often they should be cleaned, and who is responsible for cleaning them. The American Academy of Pediatrics policy statement Infection Prevention and Control in Pediatric Ambulatory Settings provides additional guidance. |
- Reduce or eliminate magazines and communal toys/books in waiting areas. Consider requesting that parents bring a toy or book for their child.
- Develop a plan and assign responsibility for thoroughly cleaning and disinfecting all surfaces, such as handrails, doorknobs, keypads, light switches, chairs, counters, and phones.
- Develop a plan and assign responsibility for thoroughly cleaning and disinfecting exam rooms after each patient exam. Any surfaces or areas that may have come in contact with the patient’s bodily fluids (e.g., blood, respiratory secretions, etc.) should be thoroughly disinfected.
- Train staff on infection prevention and occupational health policies, waiting room protocols, cleaning and disinfection practices, and other IPC strategies as part of orientation and routine in-service training. Monitor for compliance with practice policies, and document compliance assessments in employees’ personnel records.
- Reassess administrative controls at least annually as part of the practice’s routine review of IPC policies and procedures.
In Summary
Administrative IPC strategies are the basis of a thorough IPC plan. Although no two healthcare practices are exactly alike, a review of high-level administrative strategies can help practices identify potential opportunities to reduce the spread of infectious diseases and safeguard patients, visitors, clinicians, and staff members.
Each practice should (a) consider administrative controls in the context of the services offered, provider/staff needs, and patients served, and (b) adapt strategies for optimal results within the practice. Even small steps or changes in daily policy or procedure could potentially have an impact on the safety of employees, patients, visitors, and the community at large.
Resources
- Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care (Centers for Disease Control and Prevention)
- Infection Prevention and Control Assessment Tool for Outpatient Settings (Centers for Disease Control and Prevention)
- Infection Prevention and Control in Outpatient and Ambulatory Care Settings (MedPro Group)
- Standard Precautions for All Patient Care (Centers for Disease Control and Prevention)
Endnotes
1 ECRI Institute. (2020). Infection prevention & control. Ambulatory Care Risk, Quality, & Safety Guidance. Retrieved from www.ecri.org/; Centers for Disease Control and Prevention. (2015). Guide to infection prevention for outpatient settings: Minimum expectations for safe care (Version 2.2). Retrieved from www.cdc.gov/hai/settings/outpatient/outpatient-care-guidelines.html; Centers for Disease Control and Prevention. (2020, June 28). Healthcare facilities: Managing operations during the COVID-19 pandemic. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html Centers for Disease Control and Prevention. (2016, September). Infection prevention and control assessment tool for outpatient settings. Retrieved from www.cdc.gov/hai/prevent/infection-control-assessment-tools.html
