fingernails. In addition, encouraging the use of alcohol-based
gel sanitizer (containing 60 percent to 95 percent alcohol or
higher) is a vital carry-on supply if sinks are not accessible.
Discuss the importance of only using gel sanitizers if hands
are not grossly contaminated or soiled, otherwise hand
washing is required.
Cleaning and Disinfection
Another component to breaking the chain of any infection
is cleaning and disinfecting nonporous surfaces to prevent
fomite transfers:
l Start with the basics of differentiating between
cleaning and disinfection. Cleaning is the first step of
removal of foreign material (e.g., soil, organic material) from
nonporous hard surfaces before disinfection can occur. The
reason cleaning is necessary is to eliminate materials that
may interfere with the disinfection process. Disinfection is
the process of killing organisms dependent on the solution
effectiveness.
l We can’t control the general public’s choice of disinfec-
tants but encourage the use overall. Discuss how to select
disinfection products by reading labels to understand product
effectiveness to kill covered organisms. Low to intermediate
level disinfection contain chlorine-based products, phenolics,
improved hydrogen peroxide, and quaternary ammonium
compounds.
l Explain the importance of wet-contact time, which is
the amount of time the surface should be left untouched
after wiping with disinfectants to ensure organisms are
dead. The contact time can be found on the disinfectant
label depending on the brand.
l Teach high-touch wipe down (HTWD) method. Com-
mon frequently touched hard surfaces are likely introducers
to contaminating hands. This includes, but not limited to:
doorknobs, writing supplies, shared computers, desks,
kitchen tables, airport chairs, airplane passenger armrests
and tables, gasoline and credit card keypads, gasoline pump
handles, etc. It’s important to disinfect common shared items
or devices before and after use.
Masks
Disposable surgical masks are only effective as a protection
barrier for the wearer if used correctly, consistently, and
before close contact exposure from a known infected person:
l Define close-contact high risk exposure, which can be 3
feet to 6 feet without a protective mask from a symptomatic
person such as a productive cough or sneeze.
l Educate the use of disposable surgical masks properly
and the specific function:
¢ Surgical masks are designed to protect the wearer
from larger droplets (not tiny droplets that are airborne such
as measles, tuberculosis, and chickenpox).
¢ Ensure there is full coverage of nose, mouth and
chin. A mask is not protective if the nostrils are exposed,
which is a common finding in the general public
¢ Never remove masks from the front, considering
that would be the most contaminated material. Always pull
from the strings by the ears.
¢ Surgical masks are not effective if they are torn,
wet or soiled. They should also be one time use
¢ It’s critical to wear masks correctly so the wearer is
www.healthcarehygienemagazine.com • april 2020
Disposable surgical masks are only effective
as a protection barrier for the wearer if used
correctly, consistently, and before close contact
exposure from a known infected person."
inhaling/exhaling the absorbent layer and outer hydrophobic
or fluid resistant layer is protecting from larger droplets.
Common surgical masks would show the color blue as the
exterior side.
l Emphasize that masks are not effective alone to protect
the wearer, if hand hygiene is not adhered. A wearer could
be more likely to touch their face, adjusting the mask which
could introduce microorganisms to the eyes, nose or mouth
with unwashed hands.
l Lastly, discuss the difference between masks and
respirators, such as N95s. During global outbreaks and newly
emerging infectious diseases, the increase fluctuation of fears
in the general public lead to mass hysteria, which results in
a shortage of hospital supplies such as N95 respirators. In
healthcare settings, staff are fit-tested to wear appropriate
respirators and trained to check for air leaks before exposure
to airborne diseases and understand the differences of the
many respirators that are fluid and non-fluid resistant. The
general public are not fit-tested or trained.
In addition to respiratory etiquette, cleaning, disinfec-
tants and proper use of disposable surgical masks and
respirators, it’s critical to discuss vaccinations, transmission
of person-to-person spread, identify vulnerable high risk
populations (younger children, elderly, pregnant women,
Immunocompromised individuals), who to call if a suspected
person is critically ill with a respiratory infection and how to
transport the individual without exposing other people, such
as in urgent care clinics and hospital emergency departments.
In a perfect world, if every individual follows the above
recommendations, we could mitigate all respiratory infections
and experience less outbreaks. This includes vaccine prevent-
able respiratory infections such as flu, mumps, pertussis to
name a few and possible protection of COVID-19 pandemic
from what we currently know.
Jessica Alicdan is an infection control practitioner at the
University of California San Diego, Infection Prevention and
Clinical Epidemiology department. She also is an epidemiol-
ogist and Certified in Infection Control (CIC).
References:
Show me the science – when & how to use hand sanitizer in community
settings https://www.cdc.gov/handwashing/show-me-the-science-hand-
sanitizer.html
APIC Text: Cleaning, Disinfection, and Sterilization. Chetan Jinadatha,
MD, Table 31-1, Methods for Disinfection and Sterilization of Patient-Care
Items and Environmental Surfaces. https://text.apic.org/toc/basic-principles-
of-infection-prevention-practice/cleaning-disinfection-and-sterilization
Clean hands protect against infection https://www.who.int/gpsc/
clean_hands_protection/en/
Interim guidance for the use of masks to control seasonal influenza
virus transmission. https://www.cdc.gov/flu/professionals/infectioncontrol/
maskguidance.htm
37