Elimination: An example of elimination at my centre would be sterilizing. I use an autoclave to sterilize our centre’s medical instruments.
Substitution: An example of substitution would be switching from vitamin B 12 injections to oral tablets.
I give a lot of vitamin B 12 monthly injections to patients. Sometimes going back to the oral tablet may be reasonable option.
Engineering controls : An example would be having barrier glass at reception between her and the patients coming in for appointments. My receptionist will perform risk assessments on every patient coming into clinic and will report symptoms to nursing
Administrative control : An example would be employers providing routine education on infection control policies at workplace so workers are aware of IPAC guidelines specific to centre.
PPE: performing risk assessment and donning appropriate PPE. If I am doing a bedside procedure with doctor and if splash of bodily fluid is a risk I’ll wear a gown and face shield as additional precautions

Specific examples of each hierarchy of control are as follows,

Elimination
o An example of elimination would be to stop utilizing products that cause skin irritation to staff like harmful chemicals or products that are heavily scented

Substitution
o An example of substitution would be utilizing latex-free gloves as opposed to latex gloves that many staff and clients may have allergies to

Engineering controls
o Some examples of engineering controls would include sharp disposal containers in each client room and bed alarms in every bed in the unit.

Administrative controls
o An example of administrative control would be to perform regular audits of the practices followed in the facility and make any changes that may be required

PPE
o Utilizing gloves, gowns, masks, and necessary PPE when in contact with infectious diseases

Good morning Esha,
I agree that regular audits from management on policies and procedures are so important. Since taking this course I was curious about certain polices that were in place at my facility. This prompted a quick review with my manager and we identified together areas that needed to be revised.
Jessica Allison

Good morning, everyone. Here is my example of each of the Hierarchy of Controls in my current work.

Elimination: During the COVID-19 pandemic, we had to remove aerosol-generated medications such as nebulizers completely. This is to avoid the spread of other organisms through the air, both for the safety of staff and patients. During this time, no visitors are allowed in the hospital to avoid outbreaks and the spread of the disease.

Substitution: Since AGM is removed, puffer medication applied through MDI adapters attached to the ventilator machine is used as a replacement. This ensures that the medication goes into the patient as the adapter is connected to the ventilator tubes and eliminates the spread of medication in the air. Puffer medication still comes to us with a mouthpiece adaptor, but we have to take it off and only use the metal canister where the medication is in, and put it in the MDI adapter to administer medication. We also have a recreational therapy team that is responsible for setting up Zoom meetings for patients in our unit to be able to talk to their family since hospital visitation was not allowed at that time.

Engineering Control: Patients using ventilators are in private/semi-private rooms (shared washroom). Patients who are in semi-private (shared washroom) rooms are paired according to their isolation precautions (i.e., MDRO, MRSA, ESBL). Patients who do not have isolation precautions are paired with another patient who does not have isolation precautions.

Administration Control: Application of appropriate isolation signs. Most of our patient populations are on contact precaution signs (i.e., MDRO, MRSA, ESBL). This information is also available in EPR to make nurses aware of what type of isolation the patient is on. We switch to the appropriate precaution sign if there is a change in the patient’s condition. There is also a designated documentation for Covid-19 screening for patients that also flags the IPAC team. Patient families are also educated to follow hospital policy related to precaution (i.e. masking policy)

PPE: Staff are provided with appropriate PPE when doing patient care. Since our unit deals mostly with patient secretions, when providing intervention such as suctioning and IN-EX, staff must be in full PPE. The rest of the hospital may have removed the masking policy, our unit is an exception when entering patients’ rooms due to the type of intervention we have to provide. We still have our masking policy when entering and providing care in the patient’s room.

Elimination
– sanitizing exam rooms after client visit

Substitution
– self check in to reduce interactions with staff

Engineering Controls
– hand sanitizer available for both staff and clients

Administrative Controls
– regular review of policies and procedures to ensure that clients and staff are protected

PPE
– ensure that the proper PPE is available for the task at hand

Examples of hierarchy of control in a long term care home:

Elimination: Removing a broken lifting device in the bathroom to prevent injuries, transferring a patient to a hospital who has developed complex needs as a result of a disease.

Substitution: Pain medication through an IV instead of in injection form.

Engineering Controls: Mechanical transfer devices, sharps disposal containers for routine insulin shots, proper ventilation systems in all residents rooms.

Administrative controls: Ensuring enough staff are scheduled on the floor to prevent errors, on site flu shots given for both residents and staff, and training programs for staff.

Personal Protective Equipment: In the case of a stomach flu outbreak, all staff were required to wear gowns, gloves and mask entering a resident’s room and changing into new ones before entering another patient’s room.