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Infection Prevention, and Control Guidelines for Primary Care Physicians
Routine Practices
Introduction:
The term ‘Routine Practices’ evolved from the previous infection control practices of ‘Universal Precautions’ and ‘Body Substance Precautions’. Routine Practices recognizes that any individual may carry an organism that is capable of spreading disease/illness to others. Implementing best practices routinely will prevent the spread of microorganisms.
Routine Practices utilizes “barriers” in all encounters with patients whenever the staff member may come into contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin. It presumes that all persons’ blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin are infectious, regardless of whether they contain visible blood.
To begin, Routine Practices relies on the fact that a staff member must perform a risk assessment before each interaction with a patient. Following a risk assessment, the staff member must institute any number of the risk reduction strategies that Routine Practices is comprised of.
Risk Assessment:
A risk assessment must be done before each interaction with a patient and his/her environment in order to determine which interventions are required to prevent transmission of organisms.
A staff person must assess the risk of transmission of microorganisms by thinking about the task about to be performed and the status of the patient receiving care. Staff members must consider the risk of:
- Contamination of skin or clothing
- Exposure to blood, body fluids, secretions, and excretions
- Exposure to non-intact skin
- Exposure to mucous membranes
- Exposure to contaminated equipment or surfaces
- Recognition of symptoms of infection (e.g. fever, cough, diarrhea, vomiting, rash, etc.)
- Patient soiling of the environment
- Patient inability to comply with hygienic practices
Risk Reduction Strategies:
Once a staff person performs the necessary risk assessment, the staff person must then choose which risk reduction strategies are required. The risk reduction strategies that comprise Routine Practices are:
1. Appropriate patient accommodation
2. Hand hygiene
3. Appropriate use of personal protective equipment
4. Proper cleaning and disinfection of the environment and equipment
5. Proper handling of linen and waste
6. Sharps injury prevention
References:
Canadian Committee on Antibiotic Resistance (2007) Infection Prevention and Control Best Practices for Long Term Care, Home and Community Care including Health Care Offices and Ambulatory Clinics
College of Physicians and Surgeons of Ontario (2004) Infection Control in the Physician’s Office.
Health Canada Infection Control Guidelines (1999), Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care, Volume 25 S4.
Health Canada Infection Control Guidelines (1998) Handwashing, Cleaning, Disinfection and Sterilization in Health Care December, Volume 24S8
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