[Grace]

Reflection activity: Thinking of your current or a past workplace provide specific examples of each hierarchy of control – see Appendix B.

[Helen]

Examples of the hierarchy of control in my long-term care facility include:
Elimination: To lessen cross-contamination, limit or remove shared equipment, such as stethoscopes and thermometers.
Substitution: To cut down on cleaning frequency, use safer, more potent antimicrobial disinfectants.
Engineering controls: To lessen the spread of respiratory droplets, transparent walls should be installed between inhabitants.
Administrative controls: Putting infection control guidelines into practice, such as those pertaining to isolation protocols, symptom assessment, and hand cleanliness.
PPE: Giving and mandating gloves, masks, gowns, and face shields to employees who are handling bodily fluids or providing care for infected residents.
When taken together, these steps lessen the likelihood that an illness will spread.

[Bunmi]

Your examples effectively demonstrate how each level of the Hierarchy of Controls is applied in a long-term care facility setting. It’s great to see how you’re incorporating practical strategies to reduce infection risks.
I particularly like your example for Elimination—removing shared equipment like stethoscopes and thermometers is an important step in preventing cross-contamination. It’s crucial that staff are using dedicated, sanitized equipment for each resident.
Also, your mention of Substitution with more potent antimicrobial disinfectants is a great way to balance cleaning efficiency and effectiveness while minimizing the frequency of cleaning tasks.
The Engineering controls you suggested, such as transparent walls, are a strong visual and physical barrier that can help protect both residents and staff from droplet transmission, especially in high-risk areas.
Your focus on Administrative controls through the application of infection control guidelines is also key, particularly for keeping infection risks low and ensuring clear protocols are followed.
Finally, PPE remains one of the most essential safeguards, and your mention of mandatory PPE use ensures that staff are well-protected when caring for residents.
All of these steps, when combined, form a strong defense against infection and safeguard the well-being of residents and staff. Your approach reflects a thorough understanding of how to break the chain of infection in a long-term care setting.

[Yu]

Examples of the Hierarchy of Controls in the Long-Term Care Facility (from Most Effective to Least Effective):

Elimination (Most Effective): During enteric outbreaks, single-use utensils and food containers are used to eliminate potential sources of infection, thereby reducing the risk of transmission between individuals.

Substitution: Replace bleach-based cleaners with hospital-grade hydrogen peroxide-based disinfectants, which provide the same level of effectiveness while being safer for staff and residents.

Engineering Controls: Install physical barriers, such as plexiglass shields at nursing stations, to minimize direct contact and help reduce the spread of airborne pathogens.

Administrative Controls: Strengthen infection prevention through regular staff training on PPE use, daily symptom screening, and cohorting of staff and residents during outbreaks.

Personal Protective Equipment (PPE) (Least Effective): Use appropriate PPE based on the required level of precaution—for example, gloves and gowns for contact precautions.

[Adaeze]

Your post effectively showcases practical application of the Hierarchy of Controls in a long term care setting. The examples such as using single use utensils to eliminate sources of infection and substituting cleaning agents for safe alternatives are good ways of reducing infection spread.

[Gagandeep]

Here is what we follow at the care home I worked as PSW before:
Elimination:
We stopped all group activities and closed the dining hall temporarily. Instead of residents gathering in common areas, we delivered meals to their rooms to reduce contact and help stop the virus from spreading.

Substitution:
We switched from using reusable cleaning cloths to disposable disinfectant wipes. This made sure we weren’t accidentally spreading germs from one room to another while cleaning.

Engineering Controls:
Any resident showing symptoms was moved to a private room with its own bathroom. This isolated them from others and helped prevent the virus from spreading through shared spaces.

Administrative Controls:
We created a special team that took care of only the sick residents, so other staff members didn’t move between infected and healthy areas. We also added extra hand sanitizing stations, gave reminders about hand hygiene, and did daily health checks for everyone.

Personal Protective Equipment (PPE):
Staff wore gloves, gowns, and masks whenever they entered a room with a sick resident. We set up PPE stations right outside the rooms to make it easy for everyone to suit up properly before entering.

[Janecia]

Hello Gagandeep,

Thank you for sharing your insights on how your facility applies the Hierarchy of Controls for managing outbreaks. I really appreciated the practical examples you provided. In my facility, we’ve also taken similar steps, such as isolating symptomatic residents.

[Nnwuli]

Hi Gagandeep,

Thank you for sharing—your care home had such a well-rounded infection prevention strategy! I really like how each level of the hierarchy was clearly addressed. Stopping group activities and room delivering meals was a strong elimination move, and switching to disposable wipes is a great substitution that often gets overlooked but makes a big difference in preventing cross-contamination.

Creating a dedicated care team for sick residents under administrative controls is something I’ve seen work very effectively too, it really limits the risk of spread and makes staff feel more confident. And having PPE stations right outside rooms is such a smart and practical step. It’s those little details that make a big difference when time and safety are both critical.

Sounds like your team was very proactive and resident-focused. Thanks again for sharing it’s great to hear what other facilities are doing that works.

[Ping]

Hello Gagandeep,
Thank you for sharing your experience regarding hierarchy controls. From my perspective, your facility demonstrates effective use of administrative controls by establishing a team to respond to outbreak situations. This team helps prevent the spread of infection in a few key ways. First, they can quickly respond to an outbreak, reducing the speed at which the infection spreads. Second, by focusing solely on caring for affected patients, they help contain the virus or bacteria within a specific area. Additionally, by supporting the outbreak unit, the team ensures that patient care is maintained and not compromised due to staff shortages. Overall, the use of a response team is a strong and efficient administrative control strategy in infection prevention and control (IPAC).

[Yu]

Hello Gagandeep,

I really appreciate how clearly you outlined each level of control, especially the administrative measures like assigning a dedicated team for sick residents and doing daily health checks. The attention to details such as setting up PPE stations right outside the rooms shows a strong commitment to infection prevention and control. We’ve done the same at my facility to make it easier for staff to follow protocols and reduce the risk of cross-contamination. Thanks for sharing your experience!

[Anna]

This is a great job of keeping infections under control in home care. Cutting down group activities, isolating sick residents, and switching to disposable wipes all help reduce the spread. Having a dedicated team for infected residents and making PPE easily accessible protects both nurses and patients. These measures create a safer work environment, lower exposure risks, and make it easier for nurses to provide quality care.

[Adaeze]

Examples of Hierarchy of Elimination in my acute medicine unit.
Elimination: By sterilizing equipment such as Vitals machines between patients to avoid contamination.

Substitution: By using safe needles that retracts after injecting a patient than manually retracting it, which can result in a needle stick injury.

Engineering: Isolating patients in my unit on airborne precaution such as shingles to a private room with negative pressure.

Administrative controls: Through quality improvements strategies to improve hand washing in the unit and training on infection spread and control

PPE: PPE is unavoidable when caring for infectious diseases. understanding the correct PPE to wear for each precaution (contact, airborne, droplet). Correct donning and doffing is also key to avoid the transmission of infectious diseases.

[Janecia]

Examples of the Hierarchy of control in my facility for influenza virus

Elimination: Environmental service staff regularly sanitize high touch surfaces and common areas within the resident home area, this will reduce the spread of the virus.

Substitution: Disposable plates, cups and utensils are used during meal service to reduce cross contamination.

Engineering: If a resident/s show signs or symptoms of virus, the resident is placed on isolation in their room to prevent spread to others.

Administrative controls: Signage on the entrance of the facility and on the affected units to notify visitors and staff of an outbreak and to follow infection protocols.

PPE: Personal protective equipments caddies and instructional signage are placed outside the doors of the affected resident’s room.

[Bunmi]

At my current workplace, the following examples illustrate the application of the Hierarchy of Controls in infection prevention and control:
1. Elimination which the most effective
During the COVID-19 outbreak, non-essential visitors were restricted from entering the facility. This measure effectively removed a potential source of infection, helping to safeguard residents and staff.
2. Substitution
To enhance hand hygiene compliance, alcohol-based hand rub (ABHR) was used instead of soap and water when hands were not visibly soiled. This substitution helped minimize the transmission of pathogens by making hand hygiene quicker and more accessible.
3. Engineering Controls
Physical barriers, such as plexiglass, were installed at nursing stations and between residents in shared rooms. These modifications helped reduce the risk of droplet transmission during outbreaks.
4. Administrative Controls
Administrative strategies included staff training on proper PPE use, regular hand hygiene audits, clear signage for isolation precautions, and the development of resident cohorting plans to manage infectious cases effectively.
5. Personal Protective Equipment (PPE) (Least Effective – but Essential)
Staff used appropriate PPE—including gloves, gowns, masks, and face shields—when caring for residents on isolation or during outbreaks. Proper training on how to don and doff PPE was emphasized to reduce the risk of cross-contamination.

[Nnwuli]

Hierarchy of Controls

Workplace Application in the Long-Term Care where I work.

1. Elimination (Remove the hazard entirely)
Example: During a respiratory outbreak, we eliminated potential sources of infection by restricting visitors and sending symptomatic staff home immediately. This reduced exposure for both residents and staff.

2. Substitution (Replace the hazard with a safer alternative)
Example: We substituted group activities (which increased close contact) with individual in-room activities to reduce person-to-person transmission during flu season.

3. Engineering Controls (Isolate people from the hazard)
Example: We used physical barriers, such as plexiglass at nursing stations, and designated isolation rooms with separate airflow when possible. We also ensured proper ventilation in shared spaces.

4. Administrative Controls (Change the way people work)
Example: We implemented staggered staff breaks to avoid crowding in break rooms, daily symptom screening for staff and visitors, and increased training on infection control protocols.

5. Personal Protective Equipment (PPE) (Protect the worker with equipment)
Example: Staff were required to wear masks, gloves, gowns, and eye protection when providing care to residents on isolation precautions or during outbreaks. Fit testing for N95s was done for staff caring for COVID-positive residents.

[Samoya]

Hello Nwuli.
Thank you for sharing your post. Your explanation of the hierarchy of controls for a long-term care respiratory outbreak was informative. I have witnessed similar tactics employed to safeguard residents while attempting to meet their social and emotional needs, so I found your example of replacing group activities with in-room alternatives to be especially relatable. I appreciate how you highlighted the administrative controls used during the outbreak as administrative controls, are often overlooked but essential in stopping the spread of infection. Examples of these controls include staggered staff breaks and symptom screening. I was particularly impressed by the careful application of engineering controls, such as the isolation room’s distinct airflow and plexiglass barriers. All things considered, these environmental changes significantly improve safety as any of us have witnessed especially during the recent COVID-19 pandemic. Many supermarkets, restaurants and other businesses have adopted engineering controls such as plexiglass barriers since the COVID-19 pandemic. I’m interested to know if the limitations and heightened security caused any problems with resident or staff morale at your institution. If so, what tools or plans were implemented to help deal with that?

[Ping]

As a nurse working in a Long-Term facility, I have experienced how the facility applies the Hierarchy of Controls. Examples include the following:
Elimination: During outbreaks, prohibit non-essential caregivers from entering the facility to prevent the spread of the virus.
Substitution: Use disposable washcloths for a resident infected with Clostridium difficile. Engineering Controls: Provide masks at the entrance to decrease the chance of spreading the virus.
Administrative Controls: Implement infection measures by cohorting the staff in the infectious unit.
Personal Protective Equipment (PPE): PPE has been applied based on the levels of risk and type of infections

[Yiqun]

Hi, Ping

Thank you for your sharing.

I agree with you that hierarchy of Control measures you mentioned when we working in the LTC settings. The most effective way of control would be elimination and substitution and least effective way would be PPE. I do believe when we facing residents who exhibit new onset of symptoms, we have to implement all methods to ensure infection agent were determined and care quality was not compromised.

[Oluwatosin]

Here’s how the hierarchy of control applies in the long-term care (LTC) setting where I worked. This hierarchy is used to minimize or eliminate exposure to hazards ranked from most effective to least effective control:
1. Elimination: This is physically removing the hazard. It involves removing outdated or unsafe medical equipment that poses a risk to residents or staff, discontinuing the use of a medication known to have severe side effects in elderly populations, eliminating trip hazards like loose rugs or clutter in hallways, etc.
2. Substitution: This involves replacing the hazard with something less dangerous, such as substituting a high-risk medication with a safer alternative that offers similar therapeutic effects, using non-slip flooring instead of standard tiles to prevent falls, etc.
3. Engineering Controls: This is the process of isolating people from the hazard through the design of equipment. Examples of this in my workplace are installing mechanical lifts to reduce staff injuries from manually lifting residents.
4. Administrative Controls: This is changing the way people work through policies, training, and scheduling. Examples include training staff on safe medication administration to reduce errors, scheduling more frequent staff breaks to prevent fatigue-related mistakes, and adjusting staffing ratios to reduce workload and improve resident care.
5. Personal Protective Equipment: Providing protection to workers through personal protective equipment such as gowns, gloves, surgical masks, face shields, and N95 respirators that are used specifically for residents with airborne illnesses such as TB and COVID-19. Training on the effective donning and doffing technique was also provided.

[Pushpinder]

Hi Oluwatosin,

Thank you for sharing such a clear and thorough explanation of how the hierarchy of control is applied in your LTC setting. I really appreciated the specific examples you gave for each level, especially how elimination included things like removing outdated equipment or eliminating trip hazards- those are real, everyday risks that can often be overlooked. I also liked how you highlighted the importance of administrative controls like adjusting staffing ratios and training.

[Yiqun]

The examples of hierarchy of Control measures for dealing with hazards of infectious agents during flu/COVID outbreak in my workplace are as follows:

Elimination- hold group activities discouraged residents visiting their neighbors. Put symptomatic residents in single room if possible.
Substitution – cleaning high touch surface s frequently to reduce cross contamination,
Engineering controls – separate all residents and ensuring each residents will having meal individually when they were in dinning room. Provide rooms services for residents who has new onset of symptoms. Ensuring PPE and other supplies can be reached before entering each residents’ room.
Administrative controls – Screening for residents and staff, encouraged residents to having vaccination, and providing prophylactic medication for staff when flu outbreak was declared.
Personal Protective Equipment – staff needs to wear proper PPE when providing care for residents based on type of precautions.

[Samoya]

Hierarchy of Controls- Workplace Application in the Hospital

To reduce the transmission of bloodborne pathogens, the hospital initiated interventions on each level of the hierarchy of control:

Elimination: The hospital eliminated the need for recapping needles by implementing retractable syringes, which automatically withdraw the needle into the barrel after use. This removed one of the most dangerous steps in sharps handling and significantly reduced the risk of accidental injuries.

Substitution: For blood draws, the hospital substituted standard leur-lock blood collection needles with butterfly needles that feature an automatic retraction mechanism, activated by pressing a small lever on top. This substitution reduced the risk of needlestick injuries by using a safer, more controlled device during venipuncture.

Engineering Controls: Sharps containers were installed at every point of care to allow for immediate, safe disposal of used needles.

Administrative Controls: All healthcare staff completed mandatory annual training on sharps safety, which included a strict “no recapping” policy. Staff were also required to report any needle-stick injuries immediately. The hospital tracked incidents to identify patterns and implement targeted interventions. In addition, all staff complete mandatory pre-placement health assessments where vaccines such as Hepatitis B are recommended to reduce the risk of occupational exposure to infectious diseases.

Personal Protective Equipment (PPE): Gloves were worn during all procedures involving sharps. While they don’t prevent puncture wounds, they provide a layer of protection against blood exposure in the event of a needle-stick injury.

[Pushpinder]

During COVID outbreaks at my workplace, we applied several strategies based on the hierarchy of controls to protect both residents and staff.

Elimination
At my workplace, we eliminated unnecessary visitors during peak COVID-19 times to reduce the risk of virus exposure. We also paused group therapy sessions and communal dining to avoid gatherings where the virus could easily spread.
Substitution
We replaced shared medical tools like reusable thermometers with single-use or contactless digital thermometers. This reduced the risk of cross-contamination between patients.
Engineering Controls
Negative pressure rooms were used for residents with airborne infections. We ensured proper ventilation in rooms without that capability and used barriers or curtains to separate infected patients. We also installed plexiglass barriers at nursing stations.
Administrative Controls
Shift schedules were adjusted to reduce staff overlap and limit the number of people on-site at once. We had regular infection control training refreshers, posted visual reminders about handwashing, and kept a log for staff and residents’ daily symptom checks.
Personal Protective Equipment (PPE)
Full PPE, including masks (surgical or N95, depending on the case), gloves, gowns, and face shields, was worn when caring for residents in isolation. PPE stations were set up near all isolation rooms for quick and proper access, and protocols for putting on and removing PPE were followed strictly to prevent self-contamination.

[Natieja]

These are amazing suggestion as my Home uses similar strategies in order to create a safe environment for residents staff and visitors . I especially like the part that you discussed staffing as I fine sometimes the building has a lot of people moving through it especially during outbreaks I also believe that limiting how many people are in the building at once can reduce the spread of infection.

[Natieja]

Elimination : Eliminating potential fall risk, like clutter in the rooms, establishing essential furnitures and limit what can be brought in from home. Have censored lights, that turns on during motion to eliminate the need to turn on lights when patients move around in room, to avoid fall hazards.

Substitution: substitute Latex gloves to non latex gloves for alllergies concerns in staff and patients: Substituting regular dishes to disposable plates and utensils during outbreaks to minimize the spread of infection. substitute cohosting like symptoms to complete isolation during outbreaks, to reduce the spread os viruses.

Engineering controls: Bed alarm, clip alarm door, alarm , chair alarm in place in order to recognize when a high risk for falls patient is on the move, enabling staff to promptly attend to patient in order to avoid falls.

Administration Controls: iN-services/ Team huddles on specific topics that is effecting the workplace at that time. PPE, medication pass, IPAC etc.

PPE ; Appropriate signage in the correct places in the home to ensure staff and visitors is aware of the extra layer of protection that should be worn when in a certain area of the home, residents room, specific units etc. There should also be appropriate stock for PPE available to staff patients and visitors

[Anna]

Managing infectious hazards in a step-down ICU requires a systematic approach, following a structured hierarchy of control measures:

1. Elimination– Preventing exposure by screening patients before admission, ensuring sick staff stay home, and using single-use medical tools to minimize contamination risks.
2. Substitution– Replacing high-risk practices with safer alternatives, such as virtual consultations to limit exposure and using safety-engineered syringes to prevent injuries.
3. Engineering Controls – Modifying the environment for safety, including improving air filtration, using isolation rooms for high-risk patients, and enforcing thorough disinfection procedures.
4. Administrative Controls– Implementing policies and procedures to enhance safety, like strict hand hygiene requirements, symptom monitoring for staff and patients, and clear signage for infection prevention.
5. Personal Protective Equipment (PPE) – As the last protective measure, ensuring healthcare workers wear appropriate masks, gloves, gowns, and eye protection, with risk assessments guiding PPE use.

[Anna]

Managing infectious hazards in a step-down ICU requires a systematic approach, following a structured hierarchy of control measures:
1. Elimination– Preventing exposure by screening patients before admission, ensuring sick staff stay home, and using single-use medical tools to minimize contamination risks.
2. Substitution– Replacing high-risk practices with safer alternatives, such as virtual consultations to limit exposure and using safety-engineered syringes to prevent injuries.
3. Engineering Controls– Modifying the environment for safety, including improving air filtration, using isolation rooms for high-risk patients, and enforcing thorough disinfection procedures.
4. Administrative Controls – Implementing policies and procedures to enhance safety, like strict hand hygiene requirements, symptom monitoring for staff and patients, and clear signage for infection prevention.
5. Personal Protective Equipment (PPE)– As the last protective measure, ensuring healthcare workers wear appropriate masks, gloves, gowns, and eye protection, with risk assessments guiding PPE use.

[Semhar]

Hello Anna,

Your systematic approach to managing infectious hazards in a step-down ICU is comprehensive and well-structured. Each level of the hierarchy of controls plays a crucial role in enhancing safety and minimizing the risk of infection.

1. Elimination is indeed the most effective strategy. By screening patients prior to admission and ensuring that unwell staff members stay home, you’re creating a safer environment from the outset. The use of single-use medical tools is a smart way to further reduce contamination risks.

2. Substitution is a valuable strategy as well. Implementing virtual consultations not only limits exposure but also optimizes resource use. Switching to safety-engineered syringes is a proactive measure that can prevent injuries and protect both patients and healthcare workers.

3. Engineering controls like improving air filtration and utilizing isolation rooms are essential in managing infectious risks, especially for high-risk patients. These modifications create a safer physical environment that can significantly alter infection transmission dynamics.

4. Administrative controls are vital for promoting a culture of safety. Your emphasis on strict hand hygiene, symptom monitoring, and clear signage helps to keep infection prevention at the forefront of everyone’s mind, ensuring that best practices are consistently followed.

5. Finally, the proper use of PPE as a last line of defense is crucial. Ensuring that healthcare workers are equipped with appropriate protective gear based on a risk assessment is an essential component of infection control.

Overall, your detailed approach reflects a deep understanding of infection prevention in critical care settings. By implementing these measures, you are significantly contributing to the safety and well-being of both patients and staff. Thank you for sharing these insightful strategies!

[Ezegbebe]

Based on my experience in a healthcare environment, the hierarchy of controls plays a key role in reducing workplace hazards. Here are examples from my workplace that demonstrate each level of this approach:

Elimination
At a previous long-term care facility, we noticed a pattern of staff slipping due to a particular type of floor polish. After raising concerns, management decided to completely stop using that product and replaced it with a safer alternative, which significantly decreased slip incidents.

Substitution
During the COVID-19 pandemic, we moved away from using nebulizer treatments because of the increased risk of spreading airborne viruses. Instead, we began using inhalers with spacers, which helped reduce the risk of exposure to both staff and patients.

Engineering Controls
Our workplace installed hands-free sharps disposal containers in the medication room. These devices allowed staff to discard needles safely without physical contact, lowering the chance of accidental needlestick injuries.

Administrative Controls
To help reduce staff exhaustion and injury, the organization introduced rotating shifts and scheduled regular training sessions on proper lifting and body mechanics. These strategies supported a safer work environment through policy and education.

Personal Protective Equipment (PPE)
When caring for patients under isolation precautions, we used protective gear such as gloves, gowns, N95 masks, and face shields. While PPE was our last resort, it provided necessary protection when other safety measures weren’t enough.

[Ezegbebe]

Thank you, Anna, for sharing this. You provided a clear and practical overview of how the hierarchy of controls can be applied effectively in a step-down ICU setting. Well done!

[Kisha]

This is a great breakdown of the Hierarchy of controls as applied to long term care settings, really helps to visualize how layered safety measures work in practice. I especially like the example of substituting bleach with hydrogen peroxide based disinfectant.It is a good reminder that safety includes chemical exposure, not just infection control. Have you seen any facilities implement engineering controls beyond plexiglass barriers. Maybe improved ventilation systems.

[Semhar]

During COVID outbreaks in the long-term care homes where I work, we followed the hierarchy of control to contain the infection. Examples as follows
1. Substitution
Example: If possible, eliminate the presence of pathogens by isolating residents who are symptomatic or infected with a contagious disease, thus removing the source of infection from the general population.

2. Substitution:
Example: Substitute high-touch surfaces with materials that are less prone to harboring germs. For instance, using antimicrobial surfaces or coatings on frequently touched items like handrails and doorknobs can reduce the risk of infection transmission.

3. Engineering Controls:
Example: Install touchless fixtures such as automatic faucets, soap dispensers, and hand dryers in restrooms to minimize contact with surfaces and reduce the potential spread of pathogens.

4. Administrative Controls:
Example: Implementing strict visitation policies during outbreaks, including screening visitors for symptoms and limiting access to common areas, helps to control the spread of infections within the facility.

5. Personal Protective Equipment (PPE):
Example: Providing staff with appropriate PPE, such as gloves, masks, face masks, and gowns, especially when caring for residents with infectious diseases, ensures that they are protected while also reducing the risk of cross-contamination.

[Jazmin Guadalupe]

Hierarchy of Controls- Workplace Application in Retirement Homes

Elimination and Substitution.
Hazardous materials are eradicated from the residents, including highly flammable cleaning products. All this material is concentrated in a separate room, with prevention through the “design out” to minimize hazards and risk.

Engineering Controls
Involve modifying the physical environment to enhance safety and reduce risks, particularly for residents with mobility limitations or cognitive impairments. Implementing fall prevention measures installing grab bars, non-slip flooring, motion-sensor lighting, or widening doorways.

Administrative Controls
Setting up a daily meeting during outbreak events to discuss the situation, discuss control measures, identify problems and issues, find new cases, and keep updated on the staff and daily state of ill people. Prior to having direct contact for particular plan care with residents, daily screening of residents’ health condition is performed

Personal Protective Equipment (PPE):
Staff assisting with the resident’s toileting needs would wear gloves and a gown to protect themselves from potential exposure to feces. Staff interacting with the resident would wear a mask to prevent the spread of respiratory droplets. Enhanced barrier precautions, which involve more rigorous PPE use, may be necessary for residents with certain infections

[Author]

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