Infection Control: Frequently Asked Questions
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General
What does CMS stand for?
CMS is an acronym for Centers for Medicare and Medicaid Services. CMS sets the standards for
reimbursement in healthcare settings.
What should I do if there is a blood or body fluid exposure?
First, wash or irrigate the area thoroughly. Then, notify your supervisor and page the Infection
Control pager (found on the IntelliWeb) for further instructions.
Do I need to clean re-usable equipment after every patient contact?
Yes. This includes wheelchairs, stethoscopes, IV poles/pumps, etc. Follow your unit-specific
cleaning guidelines.
Can I use corrugated cardboard shipping boxes to store supplies?
No. Corrugated cardboard boxes are not appropriate as storage units in medical or clean supply
rooms. A corrugated box has more than one layer including channels of paper to give it added
strength. Corrugated shipping boxes are not permitted in either clean or sterile storage areas
because the boxes may harbor dust, bacteria, and small insects that have entered during
shipping.
Can I store clean/sterile items in the soiled utility?
No. Any sterile items placed in the soiled utility must be discarded or re-processed. The soiled
utility is considered a contaminated area and anything placed there must be cleaned or
sterilized before use.
Can I store sterile items in the hallway?
No. Sterile items must be stored according to strict temperature and humidity standards. All
sterile items must be stored in an area that monitors and records this.
Can I wear artificial nails?
Artificial nails are not allowed for those performing patient care. Nail polish of any kind may not
be worn in the ICU, NICU, or OR. Care providers outside of these settings may wear nail polish
as long as it is fresh and intact.
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Should I wear a surgical mask if I am not feeling well?
If you are not feeling well, please take a moment to consider if you should be working. Working
while ill is not safe for you or your patients. If you do feel that you can safely continue working,
a mask is a good option to prevent the spread of germs. Please note that masks should be kept
in place and not hung around your neck. Discard used masks.
Isolation & Hand Hygiene
Can I wear Personal Protective Equipment (PPE) outside of the patient's room?
No. Per CMS guidelines, gown, gloves, and mask must be discarded prior to exiting the patient
room. The patient's room is considered a "dirty" environment and the hallway is considered
clean. Do not bring soiled PPE into clean environments. In extenuating circumstances (i.e. code,
blood & body fluid spills), this is permitted.
How do I transport patient specimens without gloves?
This requires some additional planning. Bring a biohazard bag into the patient room and
prepare it to receive the specimen, collect the specimen using the appropriate PPE, then place
the specimen (urine cup, lab tube) into the open bag taking care to minimize contact with the
bag. Remove your gloves, perform hand hygiene, seal the bag, and walk the bag to the
destination.
Do I have to Wash In & Wash Out even if I am not going to touch anything in the patient's
room?
Yes. Studies show that over 90% of the time a healthcare worker enters the room, they touch
either the patient or objects in the patient's environment. This may be due to unexpected
issues that arise once the healthcare worker enters the room. Thus, our policy is to perform
hand hygiene and wear appropriate PPE regardless of how much contact with either the patient
or the patient's environment is anticipated.
When should I wash with soap and water?
Wash with soap and water when your hands are visibly soiled and when you feel like there is
something on your hands. You should also use soap and water for patients in Contact-C
isolation. You can use an alcohol-based hand rub at all other times.
Do I need to wash my hands if I wear gloves when performing patient care?
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Yes. Bacteria can pass through tiny invisible holes in gloves and your hands can become
contaminated when gloves are being removed. Thus, you must remove your gloves and wash
your hands or use alcohol hand gel after each patient contact. Also, do not reuse gloves
between patients or attempt to wash gloves.
Do I need a physician order for MDRO screening swabs?
No. As part of the our policy (Limiting unprotected exposure to pathogens—Swabbing for
colonization detection of MDROs), patients are to be swabbed upon readmission if they have a
history of MRSA or VRE as identified in the Diagnosis & Problems section of the electronic
medical record. This can be placed as a protocol order.
What swabs are necessary to resolve MRSA and/or VRE?
Collect a nasal AND rectal swab for MRSA. VRE requires a rectal swab; please remember to
specify VRE screening on order form.
Who can resolve isolation?
Please defer to Infection Control or ID to discontinue isolation. We review this daily (during the
week). If the RN thinks the patient should be resolved, please have him/her contact Infection
Control for a review. Sometimes we will put a note in the diagnosis and problems list giving
some direction.
Can I use my work phone in an isolation room?
Yes, this is allowed but the phone should be handled with clean hands. Example: RN in contact
iso room with gown and glove feeding patient when phone rings. The RN should remove her
gloves, answer the phone, hang up, clean hands, reglove, and continue. If RN were to answer
phone with gloved hands, he/she would need to clean phone with appropriate wipe (purple or
bleach wipe).
What is the sequence for donning/doffing PPE?
Donning:
1. Gown first
2. Mask or respirator
3. Goggles or face shield
4. Gloves
Doffing (removing) PPE:
1. Gloves
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2. Face shield or goggles
3. Gown
4. Mask or respirator
The sequence for removing PPE is intended to limit opportunities for self-contamination. The
gloves are considered the most contaminated pieces of PPE and are therefore removed first.
Why do I need to use soap and water for hand hygiene in C. diff rooms?
Clostridium difficile is shed in feces. Any surface, device, or material (e.g., commodes, bathing
tubs, and electronic rectal thermometers) that becomes contaminated with feces may serve as
a reservoir for the Clostridium difficile spores. Clostridium difficile spores are transferred to
patients mainly via the hands of healthcare personnel who have touched a contaminated
surface or item. Because alcohol does not kill Clostridium difficile spores, use of soap and water
is more effective than alcohol-based hand rubs because it helps to mechanically remove the
spores and wash them away.
Can I wear an N-95 mask instead of a PAPR ?
No. Our policy states a PAPR must be worn in all Airborne isolation rooms. You must meet
annual fit test requirements to wear an N-95 mask.
What should I do if I see a colleague forget to perform hand hygiene or wear PPE?
It might be intimidating to speak up when you see this happening, but please know Mercy
Health Saint Mary's endorses a culture of safety. In this culture, each colleague is expected to
give and receive feedback respectfully. You might say "Oh, by the way, I noticed you missed an
opportunity to wash your hands." Your colleague is expected to thank you for the reminder,
just as you are expected to thank anyone who reminds you.
Patient Transport
How do I signify that a patient is in isolation when they are being transported?
Isolation patients should have a clean isolation gown draped over the stretcher during
transport. However, communication between the sending and receiving healthcare workers is
the most important aspect of relaying isolation status. Isolation status should be part of each
SBAR handoff.
How do I transport an isolation patient without wearing PPE in the hallway?
Patient rooms are considered contaminated while the hospital hallways are clean. Tranporters
should wash their hands prior to entering the patient room, don appropriate PPE to assist the
patient from their bed to the transport stretcher. The transporter should then remove their
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PPE, perform hand hygiene, and transport the patient to their destination. Leaving gloves on
during transportation leads to cross contamination of doors, elevators buttons, etc.
Should I wear PPE to ambulate patients in the hallway?
No. CMS requires that all PPE be removed before leaving the patient area. If a patient cannot
contain their blood/body fluids they should not be in the hallway. The patient room is
considered contaminated, while the hallway is clean. Take the patient, not the germs, when
ambulating. Wash the patient's hand, if possible, prior to ambulation.
Food & Drink
Can I have a drink in patient care areas?
Per the Standard Precautions policy:
" 1. Eating, drinking, and applying cosmetics or lip balm is done only within designated areas
separated from contaminated areas." From an Infection Control standpoint, drinks at nursing
stations/alcoves are allowed, if they are covered. Drinks, even covered containers, are not
acceptable in areas that may be contaminated, such as WOWs. These areas may vary by unit
and each unit may have different standards based on their environment.
What are the labeling requirements for patient food?
All opened patient food must be labeled. The label must contain the following items:
1. Patient's Name:
2. Opened On:
3. Use By: (3 days out if reheated, 5 days out for all other items)
What are the labeling requirements for staff refrigerators?
CMS does not comment on this. Please refer to your unit's standards for keeping your break
room clean. Do not put staff food in the patient refrigerator.
References:
Centers for Disease Control. "Frequently Asked Questions Regarding Clostridium Difficile for Providers."
http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html
Centers for Disease Control. "Handwashing." http://www.cdc.gov/handwashing/
Centers for Medicare and Medicaid Services. Assessing hospital compliance with the condition of participation for infection control.
Mercy Health Saint Mary's. Limiting unprotected exposure to pathogens- Contact precautions. IP.02.01.01-3a
Mercy Health Saint Mary's. Limiting unprotected exposure to pathogens- Standard precautions. IP. 02.01.01-2
Mercy Health Saint Mary's. Limiting unprotected exposure to pathogens- Swabbing for colonization detection of MDROs. IP. 01.04.01-3-a
Mercy Health Saint Mary's. Safe Patient Pantry Guidelines.
University of Michigan. "Hand Hygiene." http://www.med.umich.edu/ice/info.htm
Vanderbilt University Medical Center. "Isolation Basics and Hand Hygiene." http://www.mc.vanderbilt.edu
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