Infection Prevention

In outpatient clinics, infection prevention can be challenging due to the number of patients coming in with unknown diagnoses. The goal of infection prevention is to protect patients and clinic staff from exposure to illness.

In the outpatient setting, nurses are responsible for:

• Utilizing standard precautions in the clinic and with every patient encounter.
• Identifying potential communicable diseases and implementing appropriate measures to maintain clinic safety.
• Ensuring that "Notifiable Conditions" are reported to the WA State Department of Health (DOH).

Nurses can help prevent the spread of illness in outpatient settings by utilizing Standard Precautions, which include:

• Hand hygiene - Perform hand hygiene before and after patient contact, before performing aseptic tasks, after contact with items used for patient care, after removing gloves or other PPE, and anytime you are moving from a contaminated-body site to a clean-body site while providing patient care. If your hands are visibly soiled or you have been in contact with any patient with a communicable disease, you must wash with soap and water; otherwise it is appropriate to use alcohol-based hand rubs. For more information, visit https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
• Personal Protective Equipment (PPE) - Use gloves if there will be possible contact with blood, body fluids, non-intact skin, potentially infectious materials, or mucous membranes. Gowns should be worn if there may be contact with body fluids or blood. Face protection (such as masks and googles) should be worn if there is a possibility of splashes or spraying of body fluids. For more information, visit https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html/Isolation2007.pdf
• Safe injection practices - Use aseptic technique during preparation and administration of injections. Discard injection items (needles, syringes, lancets, etc.) immediately after one-time use in a puncture-resistant, leak-proof sharps container. For more information, visit https://www.cdc.gov/injectionsafety/
• Safe handling of the environment and potentially contaminated equipment - Disinfect surfaces and equipment in the exam room after each patient encounter including counters, chairs, exam tables, environmental surfaces, and reusable medical devices (blood pressure cuffs, glucometer, etc.). Keep waiting and reception areas visibly clean. For more information, visit https://www.cdc.gov/infectioncontrol/guidelines/index.html/eic_in_HCF_03.pdf
• Cough etiquette - If any patient presents with signs of respiratory infection (congestion, cough, runny nose, increased respiratory secretions), they should be educated on proper cough etiquette which includes: covering nose/mouth when coughing or sneezing, using and disposing of tissues, and hand hygiene after contact with face or respiratory secretions. Patients with respiratory symptoms should be seated away from other patients (preferably >6 feet away) and encouraged to wear a mask in the waiting area. Notify the provider anytime a patient seeks care for respiratory symptoms. For more information, visit https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf and for flu resources visit https://www.cdc.gov/flu/professionals/infectioncontrol/

When patients call to schedule an appointment or walk in to the clinic, they should be screened for signs or symptoms of respiratory infection, including:

• Congestion/runny nose
• Cough
• Increased respiratory secretions
• Fever and/or chills

Any patient reporting respiratory symptoms or one of the following complaints should be screened by a nurse prior to siting in the waiting area:

• Known exposure to someone diagnosed with influenza, COVID-19, pertussis, measles, tuberculosis, varicella (chicken pox), or any other communicable disease
• Recent travel
• Other respiratory symptoms including shortness of breath, loss of taste or smell
• New rash with or without fever
• Signs of meningitis (stiff neck, fever, headache)
• Gastrointestinal symptoms such as vomiting or diarrhea
• Wounds or abscesses that are draining

CDC Guide to Infection Prevention for Outpatient Settings: https://www.cdc.gov/infectioncontrol/pdf/outpatient/guide.pdf

CDC Guide for Hand Hygiene in Health-Care Settings: https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf

CDC Infection Control, Isolation Precautions: https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html/Isolation2007.pdf

CDC Injection Safety: https://www.cdc.gov/injectionsafety/

CDC Infection Control Guidance and Guidelines Library: https://www.cdc.gov/infectioncontrol/guidelines/index.html/eic_in_HCF_03.pdf

CDC Guideline for Isolation Precautions: https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

CDC Flu Resources: https://www.cdc.gov/flu/professionals/infectioncontrol/

WA State DOH Notifiable Conditions Reporting Poster: https://www.doh.wa.gov/Portals/1/Documents/5100/420-027-Poster-HCF.pdf

WA State DOH List of Notifiable Conditions: https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/NotifiableConditions/ListofNotifiableConditions

Ambulatory Care Infection Control Article by David Friedel: https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/hospital-infection-control/ambulatory-care/

Recommendations of the Healthcare Infection Control Practices Advisory Committee: https://www.cdc.gov/hicpac/pdf/core-practices.pdf

Infection Prevention in the Outpatient Physician Clinic article from American Journal of Infection Control: https://www.ajicjournal.org/article/S0196-6553(15)00326-0/fulltext

Infection Prevention and Control in Pediatric Ambulatory Settings (2017) from the American Academy of Pediatrics (Volume 140, number 5. May require login): https://pediatrics-aappublications-org.ezproxy.spu.edu/content/pediatrics/early/2017/10/19/peds.2017-2857.full.pdf

Infection Control in the Outpatient Setting (2020) in UpToDate (Retrieved May 2020, requires login): https://www-uptodate-com.ezproxy.spu.edu/contents/infection-control-in-the-outpatient-setting?search=Infection%20control%20in%20the%20outpatient%20setting&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H7349173

Infection Prevention: Precautions for Preventing Transmission of Infection (2020) in UpToDate (Retrieved May 2020, requires login): https://www-uptodate-com.ezproxy.spu.edu/contents/infection-prevention-precautions-for-preventing-transmission-of-infection?search=Infection%20control%20in%20the%20outpatient%20setting&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H1662125824

Coronavirus Disease 2019 (COVID-19): Infection Control in Health Care and Home Settings (2020) in UpToDate (Retrieved May 2020, login required): https://www-uptodate-com.ezproxy.spu.edu/contents/coronavirus-disease-2019-covid-19-infection-control-in-health-care-and-home-settings?search=Infection%20control%20in%20the%20outpatient%20setting&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H2367711794

Chickenpox Overview by Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/chickenpox/symptoms-causes/syc-20351282