Healthcare Hygiene magazine September 2020 September 2020 | Page 22

TRANSMISSION DYNAMICS AND COVID-19
The Hierarchy of Controls
Combined With the Seven Aspects of Surface
Selection for Surface Evaluation and Selection
By Linda Lybert
T
• he Healthcare Surfaces
Institute has adopted
Following this a combination of the Hierarchy
hierarchy of Controls and the Seven Aspects
normally of Surface Selection™ as a quick
leads to the
guide for patient and healthcare worker
safety as it relates to surface selection.
implementation
The Hierarchy of Controls is a method of protecting
of safer workers by controlling exposures to occupational hazards.
The idea behind this has become the fundamental
systems
and the risk method of protecting workers. The control methods
of illness
at the top of the graphic are potentially more effective
and protective than those at the bottom. Following
has been
this hierarchy normally leads to the implementation
substantially of safer systems and the risk of illness has been
reduced. substantially reduced.
While this concept is typically used in industrial
hygiene, we can use the hierarchy to apply the
same concepts to protect patients from healthcare
surface-derived hazards as well. Traditionally, a
hierarchy of controls has been used as a means of
determining how to implement feasible and effective
control solutions.
The Seven Aspects of Surface Selection© uses
the same concept. There are many factors to
consider when evaluating ways to reduce the risk
of surface-related acquisition and transmission -- an
issue that has come into focus due to SARS-CoV-2
and the disease it causes, COVID-19. Some people are
still surprised to find that microbes can live on
and proliferate on surfaces. Further evaluation of
surface materials and assemblies of surface materials
in the built environment and products provides limited
information for cleaning, disinfection and, in the case
of medical devices, sterilization — recommendations
that often do not meet rigorous infection prevention
requirements.
By incorporating the Seven Aspects of Surface
Selection© with the Hierarchy of Controls, the risks
can be minimized.
The Hierarchy of Controls:
● Elimination: Physically remove the hazard;
Institutional Controls: Culture of safety
● Substitution: Replace the hazard
● Engineering Controls: Isolate people from the
hazard
● Administrative Controls: Change the way people
work and interactive with their environment
● PPE: Protect the worker and patient with barrier
controls
One representation of this hierarchy is as follows:
Surfaces are complicated. Discussion around the
impact surfaces have in infection prevention and
control creates confusion and misunderstanding. Some
believe environmental or “high-touch” surfaces like
sinks, counters, bedrails, door handles, light switches
22 september 2020 • www.healthcarehygienemagazine.com